Voidreaper2026/uk-benefit-forms-structured huggingface dataset:
Form BB1
Bereavement Payment
Q1. Were you under state pension age when your spouse or civil partner died?
Options: Yes; No
Bereavement Payment
Q2. Was your spouse or civil partner under state pension age when they died?
Options: Yes; No
Bereavement Payment
Q3. Was your spouse or civil partner over state pension age when they died and not entitled to a basic pension based on their own contributions?
Options: Yes; No
Guidance: We call this a category A pension.
Widowed Parent’s Allowance
Q4. Are you entitled to Child Benefit for one of your children or one of your spouse or civil partner’s children?
Options: Yes; No
Widowed Parent’s Allowance
Q5. Are you entitled to Child Benefit but not getting it because you or your late spouse or civil partner fell into the High Income Child Benefit charge group?
Options: Yes; No
Widowed Parent’s Allowance
Q6. Was your spouse or civil partner getting Child Benefit?
Options: Yes; No
Widowed Parent’s Allowance
Q7. If you are a woman, are you pregnant?
Options: Yes; No
Bereavement Allowance
Q8. Were you aged 45 or over when your spouse or civil partner died?
Options: Yes; No
Form 5223D Employees - Claim for loss of earnings during jury service (01.25)
Your details
1.1. Your full name
Your details
1.2. Your juror number
Your details
1.3. Your employer’s company name
Your details
1.4. Your job title
Your details
1.5. Employer’s address
Your details
1.5.1. Building and street
Your details
1.5.2. Second line of address
Your details
1.5.3. Town or city
Your details
1.5.4. County (optional)
Your details
1.5.5. Postcode
Your employer must complete this section
2.1. Enter your staff member’s net daily earnings
Guidance: Enter their net earnings for each day they work over a typical 2 week period. Net daily earnings means the amount they take home after income tax, National Insurance and all other deductions.
Your employer must complete this section
2.2. For weekends or bank holidays, the court is closed Monday and we cannot reimburse your employee for these days.
Your employer must complete this section
2.3. If your employee is not required to attend court will they be able to return to work?
Options: For a full day; For a half day; Before the end of the 2 weeks
Guidance: Yes No
Your employer must complete this section
2.4. Employer declaration
Guidance: I confirm that the information I’ve given is correct. I also understand that I may be prosecuted if I’ve given false or misleading information.
Your employer must complete this section
2.5. Signature
Guidance: on GOV.UK www.gov.uk/giving-staff-time-off-jury-service
Your employer must complete this section
2.6. Print your name
Your employer must complete this section
2.7. Date
Guidance: Day Month Year
Your employer must complete this section
2.8. Your job title
Your employer must complete this section
2.9. Phone number
Guidance: We may contact you to check details about your employee’s earnings
Your employer must complete this section
2.10. Email address
Form 5223C Benefits claimants - Claim for loss of benefits after 8 weeks of jury service (06.21)
1. Your details
1.1. Your full name
1. Your details
1.2. Your phone number
1. Your details
1.3. Your juror number
1. Your details
1.4. Name of crown court where you’re doing jury service
Ask your benefits officer or work coach to complete this section
2.1. Enter the juror’s total average benefits per day
Benefits officer declaration
2.2. Print your name
Ask your benefits officer or work coach to complete this section
2.3. Your job title
Ask your benefits officer or work coach to complete this section
2.4. Signed
Ask your benefits officer or work coach to complete this section
2.5. Date
Guidance: Day Month Year
Ask your benefits officer or work coach to complete this section
2.6. Phone number – we may call you to check details.
Form IHT70
Company details
Q1. Name of company
Company details
Q2. Full name of trust
Company details
Q3. Unique Taxpayer Reference (UTR) for the company
Company details
Q4. Date of company incorporation DD MM YYYY
Company details
Q5. Date of contribution DD MM YYYY
Company details
Q6. Amount of contribution
Company details
Q7. Main activities of the company at the date of contribution
Company details
Q8. Details of any excepted assets. Refer to Section 112 IHTA 1984. Please state ‘none’ if applicable
Company details
Q9. Name of each participator at the contribution date and the extent of their rights and interests in the company at the date of contribution
Company details
Q10. Did each of the participators own all of their shareholdings throughout the 2 years up to the contribution date?
Options: Yes; No
Guidance: Include full details in the ‘Additional information’ section overleaf
Contract for sale
Q11. Was the whole or any part of the business, or any of the company’s assets subject to a binding contract for sale at the contribution date?
Options: Yes; No
Guidance: Include full details in the ‘Additional information’ section below
Contract for sale
Q12. Additional information
Declaration
Q13. I declare that the information I have given in this form is true and complete.
Declaration
Q14. Signature Date DD MM YYYY
Form LP12
Section 1: the donor
Q1. Fill in section 1
Section 2: the attorneys
Q2. Fill in section 2
Section 3: how should your attorneys make decisions?
Q3. Mark only one box on this page with an ‘X’.
Options: I only appointed one attorney; jointly and severally; jointly; jointly for some decisions, jointly and severally for other decisions
Section 4: replacement attorneys
Q4. If you want one or more replacement attorneys, write their details in section 4 of the LPA form.
Section 5: when can your attorneys make decisions? (LPA for property and financial affairs only)
Q5. You must choose when you want your attorneys to be able to make decisions. Mark only one box with an ‘X’.
Options: as soon as my LPA has been registered (and also when I don’t have mental capacity); only when I don’t have mental capacity
Section 5: life-sustaining treatment (LPA for health and welfare only)
Q6. Sign only one option.
Options: option A – I give my attorneys authority to give or refuse consent to life-sustaining treatment on my behalf; option B – I do not give my attorneys authority to give or refuse consent to life-sustaining treatment on my behalf
Section 6: people to notify when the LPA is registered
Q7. Fill in section 6 (optional)
Section 7: preferences and instructions
Q8. Fill in section 7 (optional)
Section 9: donor’s signature
Q9. Sign your LPA
Section 10: certificate provider’s signature
Q10. The certificate provider must sign after the donor but before the attorneys.
Section 11: attorney’s and replacement attorney’s signatures
Q11. Your attorneys and replacement attorneys must write their names and sign and date your LPA.
Section 12: who’s applying to register your lasting power of attorney
Q12. Mark only one box with an ‘X’ to state whether you are the donor or attorneys and are applying to register the LPA.
Section 13: who do you want to receive the LPA?
Q13. You need to choose one person we can contact if we have any questions. This person will also receive the registered LPA document.
Options: the donor; an attorney; other
Section 14: application fee
Q14. How would you like to pay?
Options: Card; Cheque
Section 15: the donor or attorney(s) signature(s)
Q15. Whoever is applying to register the LPA (the person named in section 12 of the form) must read section 15, then sign and date it.
Special Rules
Question 01. Special Rules
Guidance: We have special rules for people who are nearing the end of life. This means people who have a progressive disease and are not expected to live longer than another 12 months. So that we can deal with your claim as quickly as possible, it is important that you send an SR1 form with your claim. The notes below tell you how to get an SR1 form. If you do not have the SR1 form by the time you have filled in the claim form, send us the claim form straight away. Please send the SR1 form when you can.
Special Rules
Question 01. Getting Attendance Allowance under the special rules means: getting the higher rate of Attendance Allowance, getting paid straight away (this means you do not have to wait until you have needed help for 6 months − but changes like those on page 10 of these notes may still affect how much money you get), and we deal with your claim more quickly.
Guidance: Claiming under the special rules for someone else: You can claim under the special rules for someone else. You do not have to tell them you are claiming for them. Tell us about them on the claim form. We will normally write to them about whether they can get Attendance Allowance, but we will not tell them anything about the special rules. If you are filling in this form as part of your job, you do not need to tell us your National Insurance number or date of birth at question 15. How to claim under the special rules: Please fill in the claim form. Tick the box at question 12 of the claim form to show you are claiming under the special rules. If you do not tick this box, we cannot normally pay you under the special rules. How to get an SR1 form: Ask your doctor or specialist for an SR1 form. This is a form about your medical condition. You won’t have to pay for it. You can ask the doctor’s receptionist, a nurse or a social worker to arrange this for you. You do not have to see the doctor. Most doctors’ practices provide SR1 forms very quickly. Ask for the form in a sealed envelope if you do not want anyone to see it.
Immigration Status
Question 08. If you are not a British or Irish national please send us your passport, travel documents and any other letters you have from the home office.
Guidance: If you are Swiss or a national of any of the EEA countries listed below and you were living in the United Kingdom (UK) before 1 January 2021 you do not need to send us anything: Austria, Italy (including Sicily, Sardinia but not Vatican City and San Marino), Belgium, Bulgaria, Latvia, Croatia, Liechtenstein, Cyprus, Lithuania, Czech Republic, Luxembourg, Denmark (but not the Faroe Islands and not Greenland), Malta, Estonia, Netherlands, Finland (but not the Aland Islands), Norway, France (including Corsica, Guadeloupe, Martinique, Reunion and French Guiana but not Monaco), Germany, Gibraltar, Greece (Including Crete and the Greek Islands), Hungary, Iceland, Republic of Ireland, Spain (including the Balearic Islands, the Canary Islands and the Spanish enclaves of Ceuta and Melilla), Sweden. If you are not a British or Irish citizen and your immigration status changes, we need to know. If you are a European Union, European Economic Area or Swiss citizen and were living in the UK by 31 December 2020 but have not applied to the EU Settlement Scheme, you and your family must apply straight away. If you have lived in the UK for 5 years or more in a row, you can apply for settled status. If you have pre-settled status this will not expire. It may be beneficial for you to apply for settled status if you have lived in the UK for 5 years or more in a row.
Residency
Question 09. Do you normally live in Great Britain?
Guidance: To be able to get Attendance Allowance you normally have to have lived in the UK for 2 years out of the last 3 and not be subject to immigration control. You may be able to meet this condition if you are, or have been, living in a European Economic Area (EEA) state or Switzerland and are covered by the Withdrawal Agreement. These rules do not apply if you are nearing the end of life and qualify under special rules. Also, if you or a member of your family live in a country that is part of the EEA, or in Switzerland, then you may be able to get Attendance Allowance if the UK is responsible for paying you sickness benefits. You can find more information about claiming Attendance Allowance when you live in a country that is part of the EEA, or in Switzerland, on our website www.gov.uk
Medical Information
Question 20. About your illnesses or disabilities and the treatment or help you receive
Guidance: Consent: We may need to contact your GP, or the people or organisations involved with you, for information about your condition(s) or treatment. This may include medical information. This is so that we understand your current needs. You do not have to agree to us contacting these people or organisations but if you do not agree, we may not be able to check you can get the payments you are claiming.
Aids and Adaptations
Question 27. What aids or adaptions do you use?
Guidance: We want to know if you use any aids or adaptations to help you do things. For example: hoist, monkey pole or bed-raiser may help you get out of bed; a commode, raised toilet seat or rails may help you with your toilet needs; bath rails, a shower seat or a hoist may help you bath or shower; a long-handled shoehorn, button hook, zip pull or sock aid may help you dress; a stairlift, raised chair, wheelchair or rails may help you move about indoors; a walking stick, walking frame, crutches or artificial limbs may help you get around; special cutlery or a feeding cup may help you eat and drink, or a hearing aid, textphone, magnifier or braille terminal may help you communicate. Please tell us if you need help to use the aids or adaptations and, if you do, what help you get from another person.
Hospital or Care Home Stay
Question 47. Being in hospital, a care home or a similar place
Guidance: By care home, we mean a home such as a residential care home, nursing home, hospice or similar place. We need to know if: you are in a hospital, a care home or similar place when you make your claim, and the local authority or NHS pay anything towards the cost of your stay. If you are awarded Attendance Allowance when you are in hospital, a care home or a similar place, we cannot pay you until you come out. But if you are a private patient or resident, paying for your stay without help from public funds, we will be able to pay you. We may still be able to pay you if you are claiming under the special rules and you are in a hospice.
Payment Details
Question 50. How we pay you
Guidance: If we pay you too much money: We have the right to take back any money we pay that you should not have got. This may be because of the way the system works for payments into an account. For example, you may give us some information, which means you should get less money. Sometimes we may not be able to change the amount we have already paid you. This means we will have paid you money that you should not have got. We will contact you before we take back any money.
Form N1 Claim form (CPR Part 7) (12.24)
Q1. Claimant(s) name(s) and address(es) including postcode
Q2. Defendant(s) name and address(es) including postcode
Q3. Brief details of claim
Q4. Value
Q5. Defendant’s name and address including postcode
Q6. Amount claimed for service including Court fee
Q7. Legal representative’s costs
Q8. Total amount
Q9. Claim no.
Q10. You must indicate your preferred County Court Hearing Centre for hearings here (see notes for guidance)
Q11. Do you believe you, or a witness who will give evidence on your behalf, are vulnerable in any way which the court needs to consider?
Options: Yes. Please explain in what way you or the witness are vulnerable and what steps, support or adjustments you wish the court and the judge to consider.; No
Q12. Does, or will, your claim include any issues under the Human Rights Act 1998?
Options: Yes; No
Q13. Particulars of Claim attached to follow
Q14. Statement of truth
Guidance: Note: you are reminded that a copy of this claim form must be served on all other parties.
Q14a. I understand that proceedings for contempt of court may be brought against a person who makes, or causes to be made, a false statement in a document verified by a statement of truth without an honest belief in its truth.
Q14b. I believe that the facts stated in this claim form and any attached sheets are true.
Q14c. The claimant believes that the facts stated in this claim form and any attached sheets are true. I am authorised by the claimant to sign this statement.
Q15. Signature
Q16. Claimant
Q17. Litigation friend (where claimant is a child or protected party)
Q18. Claimant’s legal representative (as defined by CPR 2.3(1))
Q19. Date
Q20. Full name
Q21. Name of claimant’s legal representative’s firm
Q22. If signing on behalf of firm or company give position or office held
Q23. Claimant’s or claimant’s legal representative’s address to which documents should be sent.
Q24. Building and street
Q25. Second line of address
Q26. Town or city
Q27. County (optional)
Q28. Postcode
Q29. If applicable
Q30. Phone number
Q31. DX number
Q32. Your Ref.
Q33. Email
Form IC1NI 4/17
Part 1: Your details
Part 1: Your details. Part 1: Your details
Guidance: Please write in black ink and use CAPITAL LETTERS. Please now pass this form to the professional to complete Parts 2 and 3.
Part 1: Your details
Part 1: Your details. Your name
Part 1: Your details
Part 1: Your details. National Insurance (NI) number
Part 1: Your details
Part 1: Your details. Address
Part 1: Your details
Part 1: Your details. Postcode
Part 2: Registered social worker’s contact details
Part 2: Registered social worker’s contact details. Part 2: Registered social worker’s contact details
Part 2: Registered social worker’s contact details
Part 2: Registered social worker’s contact details. Name
Part 2: Registered social worker’s contact details
Part 2: Registered social worker’s contact details. Job title
Part 2: Registered social worker’s contact details
Part 2: Registered social worker’s contact details. Authority
Part 2: Registered social worker’s contact details
Part 2: Registered social worker’s contact details. Phone number
Part 2: Registered social worker’s contact details
Part 2: Registered social worker’s contact details. Address
Part 2: Registered social worker’s contact details
Part 2: Registered social worker’s contact details. Postcode
Part 3: Registered social worker declaration
Part 3: Registered social worker declaration. Part 3: Registered social worker declaration
Guidance: HM Revenue and Customs may contact you to confirm authentication.
Part 3: Registered social worker declaration
Part 3: Registered social worker declaration. I confirm that
The claimant (name)
contacted me on / /
regarding the circumstances in
which (child’s name)
has come to live with the claimant.
Part 3: Registered social worker declaration
Part 3: Registered social worker declaration. Based on the meeting(s) I have had with the claimant in the course of my professional duties,
and any other relevant information available to me, I confirm that:
Options: The claimant has undertaken the care of the child who is normally living with them on an informal basis, and; The circumstances of the child are such that, if they were not currently in the care of the claimant, it is likely that they would be looked after by an authority.
Part 3: Registered social worker declaration
Part 3: Registered social worker declaration. Signature
Part 3: Registered social worker declaration
Part 3: Registered social worker declaration. Date
Part 3: Registered social worker declaration
Part 3: Registered social worker declaration. Registration number
Form CC1 HSCP Certificate
About the carer
01. Carer’s surname
About the carer
02. Carer’s first name
About the carer
03. Carer’s National Insurance (NI) number
About the carer
04. How many hours a week do you care for the person you look after?
About the person being cared for
05. Surname of person being cared for
About the person being cared for
06. First name of person being cared for
About the person being cared for
07. National Insurance (NI) number of person being cared for
Confirmation of care needs by a health or social care professional
08. Full name of health or social care professional
Confirmation of care needs by a health or social care professional
09. Job title
Confirmation of care needs by a health or social care professional
10. Organisation name
Confirmation of care needs by a health or social care professional
11. Daytime phone number
Confirmation of care needs by a health or social care professional
12. Organisation address
Confirmation of care needs by a health or social care professional
13. What is your professional relationship with the person being cared for?
Confirmation of care needs by a health or social care professional
14. Do you agree that the person being cared for needs the weekly amount of care stated in About the carer?
Options: No; Yes
Guidance: No Do not sign this certificate. Yes Please sign and date below.
About the carer
Signature. Signature
About the carer
Date. Date
Confirmation of care needs by a health or social care professional
Signature of health or social care professional. Signature of health or social care professional
Confirmation of care needs by a health or social care professional
Date. Date
About you
1. Title
Guidance: For example Mr, Mrs, Miss, Ms or Dr
About you
2. Your surname or family name
About you
3. Your first name
About you
4. Your address
About you
5. Your contact telephone number
About you
6. Best time to contact you
About you
7. Your date of birth DD MM YYYY
About you
8. Your National Insurance number
About you
9. Your employer PAYE reference number
Guidance: Example – 123/A246
Claim for repayment
10. Give the amount of your pension flexibility payment (you should not include any tax free part of your pension flexibility payment)
Claim for repayment
11. Have you had any income since leaving your last employment?
Options: Yes; No
Claim for repayment
12. What type of income have you received since leaving your last employment?
Options: Part time; Casual; Work/Occupational pension; State pension; Pension flexibility payment; Self-employed; Other (state below)
Claim for repayment
13. Give the amount of income received since leaving your last employment
Claim for repayment
14. Did you pay tax on this amount?
Options: Yes; No
Claim for repayment
15. Name of the employer or contractor
Claim for repayment
16. Address of the employer or contractor
Claim for repayment
17. Do you have Parts 2 and 3 of your P45?
Options: Yes; No
Claim for repayment
18. What was the total amount of pay you received?
Claim for repayment
19. Tell us below why do you not have Parts 2 and 3 of your P45? If you later find the original P45, you must not give Parts 2 and 3 to any new employer or pension provider because this may affect the tax you pay at the end of the year.
Taxable state benefits
20. Since the beginning of this tax year, have you claimed any of the taxable benefits shown below? Tick all that apply and answer the relevant questions
Options: Jobseeker’s Allowance (JSA); Incapacity Benefit (IB); Employment and Support Allowance (ESA); Carer’s Allowance (CA)
Taxable state benefits
21. The Jobcentre Plus office where you claimed
Taxable state benefits
22. If you claimed JSA, how much did you get?
Taxable state benefits
23. If you claimed IB, how much did you get?
Taxable state benefits
24. If you claimed ESA, how much did you get?
Taxable state benefits
25. If you claimed CA, how much did you get?
How we’ll make your repayment
26. Where should we send the repayment to?
Options: Your address (go to Declaration); Your nominee’s address (go to question 27 to 29)
How we’ll make your repayment
27. Name of nominee
How we’ll make your repayment
28. If your nominee is your tax advisor, enter their reference
How we’ll make your repayment
29. Nominee’s address
Declaration
30. I’m actively seeking employment and have been unemployed for 4 weeks or more and have not claimed any of the taxable benefits listed on page 1.
Declaration
31. I do not expect to go back to work (including part-time or casual employment) before the start of the new tax year on 6 April. I do not get a pension from my old employer and have not claimed any of the taxable benefits listed on page 1.
Declaration
32. I confirm I’ve read the self-assessment section on page 1 and know I must declare any repayment received on my next tax return.
Declaration
33. I can confirm that the information on this form is correct and complete to the best of my knowledge and belief.
Declaration
34. Full name
Declaration
35. Daytime telephone number (including area code)
Declaration
36. Signature
Declaration
37. Date DD MM YYYY
Declaration
38. If you’ve signed on behalf of someone else, give the capacity in which you’re signing this form
Options: Administrator; Executor; Power of Attorney; Receiver; Trustee
Q41. This is about aids and adaptations they use or have been assessed for. Aids are things like: braces, supports, crutches, buggies, wheelchairs, commodes, reading and learning aids such as computer programmes. Adaptations are things like: ramps, slopes, rails, alterations to the home, such as widened doorways. You should include any aid or adaptation they can use with or without help.
Guidance: Here are a few examples of the help they may need to use an aid or adaptation safely to: get on and off a raised toilet seat, put on and take off a back brace or incontinence pants, maintain a hearing aid, keep it clean and ensure small parts like batteries are not put in their mouth, be reminded or encouraged to use the aids, propel a wheelchair up a ramp or a slope.
Q45. This question is about how far they can walk before they stop because of severe discomfort.
Guidance: To estimate the distance they can walk it may help you to know: an average adult step is just under one metre (one yard), a double-decker bus is about 11 metres (12 yards) long, 12 cars parked end-to-end with a small gap between them would be at least 50 metres (55 yards), 2 full-size football pitches are about 200 metres (218 yards) long. It may help to do the following things when you are out walking with the child: count the steps you take to see how far they have walked. If they walk 100 of your steps, they have walked about 90 metres (100 yards), check the time when you start and stop to see how long it takes.
Q47. This question is about how they walk, please tick any boxes that describe these difficulties.
Guidance: Here are a few examples of other things you may want to tell us: they may refuse to walk even if they physically can, they may have a stiff leg causing uneven steps, they may have an upper body stoop which causes a lack of balance, you may want to give more details on the boxes you have ticked, you may want to tell us anything else you think we should know about their walking difficulties.
Q49. These are about needing someone to guide or supervise them most of the time when outdoors. Guide means to physically lead or verbally direct them to safely find their way around. Supervise means checking routes for dangers or obstacles, keeping an eye on how they are and if they can carry on walking. It includes coaxing, encouraging, persuading or talking so they carry on walking to avoid danger.
Guidance: For example: If they walk safely next to a busy road without putting themselves or others in danger but cannot cross a road safely, you would answer like this: Can they walk safely next to a busy road? No Yes. Can they cross a road safely? No Yes.
Q53. Here are a few examples of other things you may want to tell us. It is not a full list and does not cover everything. They may: follow simple directions but would not ask for help if lost, accept sweets or a ride in a car even if they did not know the person, get upset by traffic noise or crowds, and panic, suddenly run across the road if they see a friend on the other side, only be able to cross roads using a pedestrian crossing, become unsteady and may fall.
Q54. This is about help needed to get in, out, or settle in bed during the day. It can be encouragement, prompting or assistance.
Guidance: For example: If they need encouragement to get out of bed in the morning and again after an afternoon nap, and it takes 4 minutes each time, you would answer like this: How often each day do they need encouragement, prompting or assistance to help to get into bed? Twice. How many minutes does this take each time? 4.
Q55. This is about help needed to go to or use the toilet during the day. It can be encouragement, prompting or assistance.
Guidance: For example: If they need to be prompted to go to the toilet, to take their underwear down, to wipe and clean themselves and to wash and dry their hands, you would answer like this: They need encouragement, prompting or assistance to: go to the toilet, manage clothes, get on and off the toilet, wipe and clean themselves, wash and dry their hands, manage a catheter, ostomy or stoma, manage nappies or pads.
Q56. This is about help needed to move around indoors during the day. It can be encouragement, prompting or assistance.
Guidance: For example: If they need assistance to get up and down stairs, you would answer like this: They need encouragement, prompting or assistance to: go up and down one step, go upstairs, go downstairs, move around safely, get into or out of a chair, sit in a chair.
Q57. This is about help needed to keep clean and check their appearance during the day. It can be encouragement, prompting or assistance.
Guidance: For example: If they need assistance to have a wash but do not need assistance to clean their teeth, you would answer like this: How often each day do they need prompting or assistance to wash or bathe? 5. How many minutes does this take each time? 2. How often each day do they need prompting or assistance to clean their teeth? 0. How many minutes does this take each time? 0.
Q58. This is about help needed to dress or undress during the day. It can be encouragement, prompting or assistance.
Guidance: For example: If they need assistance to manage buttons, when putting a coat on and off to go to and from school, and it takes about a minute each time, you would answer like this: How often each day do they need encouragement, prompting or assistance to manage zips, buttons or other fastenings? 4. How many minutes does this take each time? 1.
Q59. This is about help needed to eat and drink during the day. It can be encouragement, prompting or assistance.
Guidance: For example: If they use a spoon to eat but need help to cut up the food at each meal, and this takes about 2 minutes each time, you would answer like this: How often each day do they need encouragement, prompting or assistance to cut up food on their plate? 3. How many minutes does this take each time? 2.
Q60. This is about help needed to take medicine or have therapy during the day. It can be encouragement, prompting or assistance.
Guidance: For example: If they need to be prompted to take their medication twice a day, you would answer like this: How often each day do they need encouragement, prompting or assistance to know when to take their medication? 2. How many minutes does this take each time? 5.
Q61. This is about difficulty seeing.
Guidance: For example: If they can see well enough to recognise someone’s face across a room but cannot recognise someone across a street, you would answer like this: Can they recognise someone’s face across a room? No Yes. Can they recognise someone across a street? No Yes.
Q62. This is about difficulty hearing.
Guidance: For example: If they can hear a loud voice in a quiet room but cannot hear a normal voice in a quiet room, you would answer like this: Can they hear a normal voice in a quiet room? No Yes. Can they hear a loud voice in a quiet room? No Yes.
Q63. This is about difficulty speaking.
Guidance: For example: If they speak clearly in sentences, you would answer like this: Can they speak clearly in sentences? No Yes.
Q64. This is about difficulty communicating.
Options: Writing; British Sign Language (BSL); Lip reading; Using hand movements, facial expressions and body language; Makaton; Signed Supported English (SSE); Signed English (SE); Finger spelling; Picture Exchange Communication System (PECS); Tadoma
Guidance: For example: If they communicate using Makaton but only with people they know, you would answer like this: Do they use any of the following to communicate? Tick all that apply. Writing British Sign Language (BSL) Lip reading Using hand movements, facial expressions and body language Makaton Signed Supported English (SSE) Signed English (SE) Finger spelling Picture Exchange Communication System (PECS) Tadoma. Can they communicate with someone they know? No Yes. Can they communicate with someone they do not know? No Yes.
Q65. This is about fits, blackouts, seizures or something similar.
Guidance: For example: If they blackout a couple of days a month and have no warning, you would answer like this: Do they have fits, blackouts, seizures, or something similar? This means epileptic, non-epileptic or febrile fits, faints, absences, loss of consciousness and ‘hypos’ (hypoglycaemic attacks). See page 21 of information booklet. No Yes. Tell us what type they have and what happens: Doctors do not know the kind of fit they have. They drop to the floor and lie for 2 minutes. Do they have any warning before a fit, blackout or seizure? No Yes Sometimes.
Q66. This is about needing someone to supervise them during the day.
Guidance: For example: If they regularly become verbally aggressive and act impulsively, you would answer like this: Do they regularly become verbally abusive or display distressed behaviours that can cause harm to themselves or others? No Yes. Do they regularly act impulsively? No Yes.
Q67. This is about help needed with their development.
Guidance: For example: If they will play on their own but not with others, you would answer like this: Do they need help to play with others? No Yes. Do they need help to play on their own? No Yes.
Q68. This is about the help needed at school or nursery. It can be encouragement, prompting or assistance.
Guidance: For example: If they need help to communicate and need extra help with learning, you would answer like this: Do they need encouragement, prompting or assistance to communicate? No Yes. What extra help do they need with their learning? They spend 2 days a week in the school’s special unit where they get one-to-one help. The school also provide exercises for them to do at home.
Q69. This is about difficulty taking part in hobbies, interests, or social or religious activities.
Guidance: For example: They go to a youth club once a week. At the club, they are encouraged to join in the activities with other children. The help is needed for 2 hours. They would go on nature trails and similar activities at weekends. They would need help to get to and from the activity, push the wheelchair, get to and from the toilet and general moving around. This would be for about 2 to 3 hours.
Q70. This is about help needed at night. It can be encouragement, prompting or assistance. It can also be watching over them for their or others’ safety.
Guidance: For example: If someone needs to watch over them because they wake up and wander about, but not because they have behavioural problems, you would answer like this: On average how many nights each week do they need supervision because they may wander about? 1. How many minutes does this take each time? 10. How many times a night do they need the help? 1. On average how many nights each week do they need supervision because they have behavioural problems? 0. How many minutes does this take each time? 0. How many times a night do they need the help? 0.
Q73. Name: Enter your current full legal name as it appears on your passport, deed poll, gender recognition certificate or other legal documents.
Q74. Date of Birth: Provide your date of birth in the format DD/MM/YYYY.
Q75. Address: You only need to complete this section if: your address is different to the child’s address you are making a DLA Child claim for, or you would like us to write to you at a different address.
Q76. Contact Details: Provide your current telephone number and email address.
Q77. Nationality: State your nationality as per your passport or other legal documents. For example, British, Polish, Indian.
Q84. By giving us the account details you: agree that we will pay DLA into an account, and understand what we have told you above in the section If we pay too much money.
Q85. If you are going to open an account, please tell us the account details as soon as you get them.
Q86. If you do not have an account, please contact us and we will give you more information.
Q87. About the account you want to use: you can use an account in your name, or a joint account, you can use a credit union account. You must tell us the credit union’s account details. Your credit union will be able to help you with this, if you are an appointee or a legal representative acting on behalf of the customer, the account should be in your name only.
Q88. You can find the account details on the debit card, statement or chequebook. If you do not know the account details, ask the bank or building society.
Section 1 - Your details (the applicant)
1.1. Your details Mr. Mrs. Miss Ms. Other First name Middle name(s) Last name
Section 1 - Your details (the applicant)
1.2. Address (including postcode) Telephone no. Daytime Evening Mobile E-mail address
Section 1 - Your details (the applicant)
1.3. Is a solicitor representing you? Yes No If Yes, please give the solicitor’s details. Name Address (including postcode) Telephone no. Fax no. DX no. E-mail address
Section 1 - Your details (the applicant)
1.4. To which address should all official documentation be sent? Your address Solicitor’s address Other address (please provide details)
Section 1 - Your details (the applicant)
1.5. Your description Attorney Other person entitled to be notified of the application to register the LPA
Section 2 - Objection to the registration of an LPA
2.1. Full name of the donor Mr. Mrs. Miss Ms. Other First name Middle name(s) Last name
Section 2 - Objection to the registration of an LPA
2.2. Full name of intended attorney(s) Mr. Mrs. Ms. Miss Other First name Last name Mr. Mrs. Ms. Miss Other First name Last name
Section 2 - Objection to the registration of an LPA
2.3. Date donor signed the LPA D D M M Y Y Y Y
Section 2 - Objection to the registration of an LPA
2.4. Date you were given notice of the application to register the LPA D D M M Y Y Y Y
Section 2 - Objection to the registration of an LPA
2.5. You can only object to the court against the registration of the LPA on grounds which are prescribed in regulations under the Mental Capacity Act 2005. Please indicate your grounds for objecting to the proposed registration: The power purported to be created by the instrument* is not valid as a LPA. (e.g. the donor did not have capacity to make an LPA). The power created by the instrument no longer exists (e.g. the donor revoked it at a time when he or she had capacity to do so) Fraud or undue pressure was used to induce the donor to make the power. The attorney proposes to behave in a way that would contravene his authority or would not be in the donor’s best interests. *The instrument means the LPA made by the donor.
Options: The power purported to be created by the instrument* is not valid as a LPA. (e.g. the donor did not have capacity to make an LPA).; The power created by the instrument no longer exists (e.g. the donor revoked it at a time when he or she had capacity to do so); Fraud or undue pressure was used to induce the donor to make the power.; The attorney proposes to behave in a way that would contravene his authority or would not be in the donor’s best interests.
Section 2 - Objection to the registration of an LPA
2.6. Any evidence in support of your application must be filed with this application Evidence attached form. If you are attaching any written evidence please use the COP24 witness statement form.
Section 2 - Objection to the registration of an LPA
2.7. You must have notified the Public Guardian of your intention to apply to the I confirm that I have court to object to the registration of the LPA. (See note 1) notified the Public Guardian
Options: I confirm that I have notified the Public Guardian
Section 3 - Attending court hearings
3.1. If the court requires you to attend a hearing do you need any special Yes No assistance or facilities? (See note 2) If Yes, please say what your requirements are. If necessary, court staff may contact you about your requirements.
Section 4 – Statement of truth
4.1. The statement of truth is to be signed by you, your solicitor or your litigation friend. *(I believe) (The applicant believes) that the facts stated in this application form are true. Signed *Applicant(’s litigation friend)(’s solicitor) Name Date Name of firm Position or office held * Please delete the option in brackets that do not apply.
Form COP1F
Section 1 - Your application
1.1. Your name
Section 1 - Your application
1.2. Your description
Options: Donor; Attorney/Donee; Sole; Joint; Joint and several; Other
Guidance: (please give details)
Section 2 - Details of EPA/LPA
2.1. Full name of attorney(s)/donee(s)
Options: Mr.; Mrs.; Miss; Ms.; Other
Section 2 - Details of EPA/LPA
2.2. Date donor signed the EPA/LPA
Section 2 - Details of EPA/LPA
2.3. Date of registration (if applicable)
Section 2 - Details of EPA/LPA
2.4. I enclose a copy of the EPA/LPA (For LPAs only)
Options: It is a property and financial affairs LPA; It is health and welfare LPA
Section 2 - Details of EPA/LPA
2.5. Please state the order you are asking the court to make?
Section 2 - Details of EPA/LPA
2.6. You must file a COP24 witness statement in support of your application and relevant exhibits if necessary
Section 3 - Statement of truth
3.1. (I believe) (The applicant believes) that the facts stated in this annex are true.
Options: (I believe); (The applicant believes)
Guidance: * Please delete the options in brackets that do not apply.
Section 3 - Statement of truth
3.2. Signed
Section 3 - Statement of truth
3.3. Name
Section 3 - Statement of truth
3.4. Date
Section 3 - Statement of truth
3.5. Name of firm
Section 3 - Statement of truth
3.6. Position or office held
Section 1 - Your application
1.1. Your name
Section 1 - Your application
1.2. Your description
Section 2 - Details of EPA/LPA
2.1. Full name of attorney(s)/donee(s)
Options: Mr.; Mrs.; Miss; Ms.; Other
Section 2 - Details of EPA/LPA
2.2. Date donor signed the EPA/LPA
Section 2 - Details of EPA/LPA
2.3. Date of registration (if applicable)
Section 2 - Details of EPA/LPA
2.4. I enclose a copy of the EPA/LPA (For LPAs only)
Options: It is a property and financial affairs LPA; It is health and welfare LPA
Section 2 - Details of EPA/LPA
2.5. Please state the order you are asking the court to make?
Section 2 - Details of EPA/LPA
2.6. You must file a COP24 witness statement in support of your application and relevant exhibits if necessary
Section 3 - Statement of truth
3.1. (I believe) (The applicant believes) that the facts stated in this annex are true.
Options: (I believe); (The applicant believes)
Guidance: * Please delete the options in brackets that do not apply.
Section 3 - Statement of truth
3.2. Signed
Section 3 - Statement of truth
3.3. Name
Section 3 - Statement of truth
3.4. Date
Section 3 - Statement of truth
3.5. Name of firm
Section 3 - Statement of truth
3.6. Position or office held
Form LPA005
Q1. Donor details (the person who made the lasting power of attorney)
Q1a. Title First names Last name Address Postcode
Q2. About the lasting power of attorney (LPA)
Q2a. What type of LPA is it?
Options: Property and financial affairs; Health and welfare
Q2b. When did the donor sign the LPA?
Guidance: To find out, look at Part A of the LPA if it was made before 1 July 2015 or section 9 if it was made on or after that date
Q2c. Was the LPA registered by the Office of the Public Guardian?
Options: Yes; No
Guidance: see page 1 of the LPA – the section marked ‘OPG office use only’
Q2d. When was the LPA registered?
Q2e. What is the ‘OPG reference number’?
Guidance: see page 1 of the LPA
Q3. Disclaiming attorney details (the person sending this notice)
Q3a. Title First names Last name Address Postcode Phone number
Q4. Signature and date
Guidance: I disclaim my appointment as attorney under the lasting power of attorney made by the donor named on this form. I will send copies of this form to any other attorneys named on the lasting power of attorney and to the Office of the Public Guardian:
Q4a. Signature or mark Date signed Day Month Year
Q1. Donor details (the person who made the lasting power of attorney)
Q1a. Title First names Last name Address Postcode
Q2. About the lasting power of attorney (LPA)
Q2a. What type of LPA is it?
Options: Property and financial affairs; Health and welfare
Q2b. When did the donor sign the LPA?
Guidance: To find out, look at Part A of the LPA if it was made before 1 July 2015 or section 9 if it was made on or after that date
Q2c. Was the LPA registered by the Office of the Public Guardian?
Options: Yes; No
Guidance: see page 1 of the LPA – the section marked ‘OPG office use only’
Q2d. When was the LPA registered?
Q2e. What is the ‘OPG reference number’?
Guidance: see page 1 of the LPA
Q3. Disclaiming attorney details (the person sending this notice)
Q3a. Title First names Last name Address Postcode Phone number
Q4. Signature and date
Guidance: I disclaim my appointment as attorney under the lasting power of attorney made by the donor named on this form. I will send copies of this form to any other attorneys named on the lasting power of attorney and to the Office of the Public Guardian:
Q4a. Signature or mark Date signed Day Month Year
Form EP5
Donor details
Q1. Donor details (the person who made the enduring power of attorney)
Donor details
Q1a. Title First names Last name Address Postcode
About the EPA
Q2. About the EPA
About the EPA
Q2a. When did the donor sign the EPA?
About the EPA
Q2b. Was the EPA registered by the Office of the Public Guardian?
Options: Yes; No
About the EPA
Q2c. When was the EPA registered?
About the EPA
Q2d. What is the ‘OPG reference number’? (If you know it)
Disclaiming attorney details
Q3. Disclaiming attorney details (the person sending this form)
Disclaiming attorney details
Q3a. Title First names Last name Address Postcode Phone number Email
Signature and date
Q4. Signature and date
Signature and date
Q4a. I disclaim my appointment as attorney under the enduring power of attorney made by the donor named on this form. I will send copies of this form to any other attorneys named on the enduring power of attorney and to the Office of the Public Guardian:
Signature and date
Q4b. Date signed Day Month Year
Q1. Donor details (the person who made the enduring power of attorney)
Q1a. Title First names Last name Address Postcode
Q2. About the EPA
Q2a. When did the donor sign the EPA? Day Month Year
Q2b. Was the EPA registered by the Office of the Public Guardian? Yes No
Options: Yes; No
Q2c. When was the EPA registered? Day Month Year
Q2d. What is the ‘OPG reference number’? (If you know it)
Q3. Disclaiming attorney details (the person sending this form)
Q3a. Title First names Last name Address Postcode Phone number Email
Q4. Signature and date
Q4a. I disclaim my appointment as attorney under the enduring power of attorney made by the donor named on this form. I will send copies of this form to any other attorneys named on the enduring power of attorney and to the Office of the Public Guardian: Signature or mark Date signed Day Month Year
Form TC-DB3 (TCPPI)
Your details
1. Name
Your details
2. National Insurance number
Your details
3. Date of birth DD MM YYYY
Your details
4. Current address
Your details
5. Telephone number – including area code
Guidance: We need this to contact you once we have received your application
Your details
6. Date you originally claimed asylum DD MM YYYY
Guidance: If you claimed on or after 1 February 2019 you’re not eligible to apply
Your details
7. Date you were granted asylum DD MM YYYY
Guidance: If this was not within 1 month of today’s date you’re not eligible to apply
Your details
8. When you claimed asylum, how many children do you have who were either: •under 16 • over 16 and in full time non-advanced education?
Guidance: If you have no children in either of these categories you’re not eligible to apply
Your details
9. Full address when you originally claimed asylum
Your partner’s details if applicable
10. Name
Your partner’s details if applicable
11. National Insurance number
Your partner’s details if applicable
12. Date of birth DD MM YYYY
About you
4. Your address
Guidance: Example – 123/A246
About you
9. Your employer PAYE reference number
About you
10. Tax year you are claiming for YYYY – YY
Employment income
11. Do you expect to receive income from paid employment during the tax year you’re claiming for?
Options: No; Yes
Self-employment income
12. Do you expect to make any self-employment profits during the tax year you are claiming for?
Options: No; Yes