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BCON/NINEDAY
BCON/NINEDAY ClCS Account and case numbers: 016213514 01623514
CIC| Account and case numbers: 016213514 01623514

2.
If you have answered NO to questions 1 & 2, please provide details of how to pay
Did you do you or your partner receive any Yes your day to day living needs i.e. food, clothing, heating etc... If you are supported
other income or benefits, such as state by friends/family we v rill need to see evidence of this.
retirement pension, tax credits or incapacity
benefit?

If Yes, please list them below and provide proof

Have you applied for Working Tax Credit? No
Did / you and your partner have any

If Yes, when did you apply: No bank or building society accounts, savings
or investment during this period?

If Yes, please list them below and provide proof of the amounts held for the
above period. Please provide the last two full months statements for every bank
3 or building society for you and your partner including the one that your income

Have you/your partner reapplied for Support or Job Seekers Allowance was paid Into.

Income Support YES (NO;

Job seekers Allowance YES

If YES when did you reapply

If you ave reapplied for benefit, it may not be continuous from the
Date till your previous entitlement ended. Therefore, we will not be
able to pay you more benefit unless we Have proof of your Income
during these periods:

75