Form SSCS5
Section 1: Your details
Q1. Section 1: Your details Use BLOCK CAPITALS
Fill in this section if you are:
• appealing a decision about your benefits OR
• appointed by HMRC or a court to deal with someone else’s benefits
Do not put your details here if you are helping someone fill in this form but you have not been officially appointed by HMRC or a court to deal with their benefits.
Section 1: Your details
Q1a. Mr Mrs Miss Ms Doctor Reverend
First name Last name
Address line 1 Date of birth (DD/MM/YYYY)
/ /
Address line 2 National Insurance number
Address line 3 Letters Numbers Letter
Do not provide your National Insurance number if
you have been appointed by HMRC or a court to deal
Postcode
with someone else’s benefits.
Section 2: About your benefit appeal
Q2. Section 2: About your benefit appeal
Which benefit is your appeal about?
The name of the benefit is shown on any letter you have received about it.
Options: Tax Credit; Child Benefit; Guardian’s Allowance; 30 hours free Childcare; Tax-Free Childcare; Guaranteed Minimum Pension; Home Responsibilities Protection; National Insurance Credits
Section 2: About your benefit appeal
Q3. When is your Mandatory Reconsideration Notice (MRN) dated?
Enter the date from the top right of your MRN letter (or if you are appealing a Tax Credit decision and have
not asked for a mandatory reconsideration the date of your original decision). For example 27/04/2020
/ /
Section 2: About your benefit appeal
Q4. If the date you have entered is over one month from today’s date, briefly explain why your appeal is late.
You need a Mandatory Reconsideration Notice (MRN) before you can appeal all benefit decisions except Tax
Credit decisions. If you do not have an MRN, you should explain why in the space provided below or confirm that
the decision notice you received from the HMRC told you that you did not need one.
Section 2: About your benefit appeal
Q5. Confidentiality
Normally there are only two parties to the appeal, you and HMRC. Clearly HMRC will know all about you.
However, sometimes the dispute you have with HMRC may involve another person.
For example both parents (or another adult) may be claiming Child Benefit. In such cases that other person might
be joined as a party to the appeal.
As that other party has a right to see all the evidence submitted as part of the appeal there will be occasions
when certain types of evidence, such as bills or bank statements are received which will include your home
address. The other party to the appeal will have the right to see this evidence. If, however, you do not want the
other party to know your current address (and they do not already know it), you can ask for your address to be
kept confidential. If you do this, any piece of evidence received relating to you will be scrutinised by HMCTS staff
and will be edited to remove all address details before it is circulated.
Section 2: About your benefit appeal
Q6. I want my home address to be kept confidential.
Yes
No
Options: Yes; No
Section 2: About your benefit appeal
Q7. If you are appealing for yourself, go to section 4
If you are an appointee, go to section 3
Section 3: About the person you are appointed to support
Q8. Section 3: About the person you are appointed to support Use BLOCK CAPITALS
Only fill in this section if you have been officially appointed by HMRC or a court to deal with someone’s
benefits. Put their details in this section.
Section 3: About the person you are appointed to support
Q9. Their details
Mr Mrs Miss Ms Doctor Reverend
Their first name Their last name
Their date of birth (DD/MM/YYYY) Their National Insurance number
/ /
Letters Numbers Letter
Their address
Only enter their address if it is different from yours.
Address line 1
Address line 2
Address line 3
Postcode
Section 4: About your representative (if you have one)
Q10. Section 4: About your representative (if you have one) Use BLOCK CAPITALS
Fill in this section if you have someone helping you with your appeal and you would like them to be your
‘representative’. This might be someone from your local advice centre, law centre or Citizens Advice. It could
also be a carer, friend or family member.
Section 4: About your representative (if you have one)
Q11. Registering a representative means they can:
• help you submit your appeal or prepare your evidence
• act on your behalf (they should ask your permission first)
• see any evidence that is submitted by you or HMRC (including financial evidence)
By entering their details here and signing this form, you are authorising the tribunal to deal with your
representative as well as you, about your appeal.
Provide as much information as you can about your representative. If you want to appoint a representative later,
then you must send us the details in writing to the address at the end of this form.
Mr Mrs Miss Ms Doctor Reverend
First name Last name
Organisation (if they work for one)
Address line 1
Address line 2
Address line 3
Postcode
Email address
Your representative will receive email updates and a link so they can manage your appeal online.
Mobile phone number
Text message updates
Tick this box if your representative would
like to receive text message updates.
Landline number (if they have one)
You should check that your representative
is happy to receive text message updates.
Section 5: The reasons for your appeal
Q12. Section 5: The reasons for your appeal
This is where you explain to the tribunal why you are appealing. The tribunal use this information, and any
evidence that you and HMRC submit, to help them make a decision on your appeal.
HMRC should have explained their decision in the Mandatory Reconsideration Notice or the original Decision
Notice if you are appealing a tax credit appeal.
Write what you disagree with and why you disagree with it.
You can write as much as you want but you must provide at least one reason.
Section 5: The reasons for your appeal
Q13. (Continue your reasons on page 12, if you run out of space.)
Providing evidence to support your benefit appeal
You can include your evidence with this appeal form or you can send it later. You should provide evidence as early
as possible in your appeal, so the tribunal have time to review it before they make a decision.
You do not have to send in evidence. Any evidence you do send will be shared with HMRC and your
‘representative’, if you have one.
Section 6: Your appeal hearing
Q14. Section 6: Your appeal hearing
Your appeal will be decided by the tribunal using the information in this form and any additional evidence you
provide. Information and evidence submitted by HMRC will also be considered.
Or you can also explain your reasons for appealing by taking part in the hearing, by telephone, video or
face-to-face.
Section 6: Your appeal hearing
Q15. I want to take part in the hearing. Go to Section 6a
I do not want to take part in the hearing. Go to Section 9
Options: I want to take part in the hearing.; I do not want to take part in the hearing.
Section 6a: Your telephone, video or face to face hearing
Q16. Section 6a: Your telephone, video or face to face hearing
The type of oral hearing will be at the discretion of the tribunal.
Please select all the suitable options for you to take part in the hearing.
Section 6a: Your telephone, video or face to face hearing
Q17. Telephone (you’ll need somewhere quiet and private to speak). Please give us your preferred telephone
number if different from above.
Video (you’ll need access to a computer or mobile device with a good internet speed and somewhere quiet
and private to speak). Please give us your preferred email address if different from above.
Face to face (you will need to travel to the hearing in person). Go to Section 7
Section 7: Support at your hearing
Q18. Section 7: Support at your hearing Use BLOCK CAPITALS
If you want to take part in the hearing and need support to be arranged by the tribunal, tell us now so we can
arrange it. Any support we provide is free of charge.
You cannot use your own interpreter at the hearing. Provide details below, if you need one.
Section 7: Support at your hearing
Q19. Language interpreter
Language Dialect
Sign language interpreter
Sign language
Hearing loop Accessible hearing room
Any other support that you need the tribunal to arrange which could be for a physical or mental health condition
Section 8: Your availability for a hearing
Q20. Section 8: Your availability for a hearing
Only fill this section in if you want to take part in the hearing.
You should make yourself available for the hearing but if you have dates you cannot attend, then fill them in
below. If you have a representative please also include any unavailability for them.
Section 8: Your availability for a hearing
Q21. I will make myself available for the hearing whenever it’s scheduled. I have no dates to avoid.
Go to section 9
Please note: This includes agreeing to HMCTS offering you a hearing at short notice due to a cancellation
(within 14 days of the date of the hearing). We will call you to confirm if you are available if offering a date
with less than 14 days notice.
I need to tell the tribunal about dates that I cannot attend a hearing (fill them in below)
Only provide dates between 3 and 8 months in the future.
Section 9: Sign and post
Q22. Section 9: Sign and post
The information I have provided in this appeal application is accurate, to the best of my knowledge.
I give the tribunal permission to correspond with my named representative about my appeal (if you gave details
of a representative).
Section 9: Sign and post
Q23. Name (in BLOCK CAPITALS)
The person named on the appeal in section 1
Signature
The person named on the appeal in section 1
Date (DD/MM/YY)
/ /
Section 9: Sign and post
Q24. Where to post your appeal form
You need to send your appeal form and a copy of the Mandatory Reconsideration Notice (MRN) or copy of
original decision notice needed to HM Courts & Tribunals Service.
If you live in England or Wales send your appeal to: If you live in Scotland send your appeal to:
Section 9: Sign and post
Q25. HMCTS Benefit Appeals HMCTS SSCS Appeals Centre
PO Box 12626 PO Box 13150
Harlow Harlow
CM20 9QF CM20 9TT
Section 1: Your details
Q1. Section 1: Your details Use BLOCK CAPITALS
Fill in this section if you are:
• appealing a decision about your benefits OR
• appointed by HMRC or a court to deal with someone else’s benefits
Do not put your details here if you are helping someone fill in this form but you have not been officially appointed by HMRC or a court to deal with their benefits.
Section 1: Your details
Q1a. Mr Mrs Miss Ms Doctor Reverend
First name Last name
Address line 1 Date of birth (DD/MM/YYYY)
/ /
Address line 2 National Insurance number
Address line 3 Letters Numbers Letter
Do not provide your National Insurance number if
you have been appointed by HMRC or a court to deal
Postcode
with someone else’s benefits.
Section 2: About your benefit appeal
Q2. Section 2: About your benefit appeal
Which benefit is your appeal about?
The name of the benefit is shown on any letter you have received about it.
Options: Tax Credit; Child Benefit; Guardian’s Allowance; 30 hours free Childcare; Tax-Free Childcare; Guaranteed Minimum Pension; Home Responsibilities Protection; National Insurance Credits
Section 2: About your benefit appeal
Q3. When is your Mandatory Reconsideration Notice (MRN) dated?
Enter the date from the top right of your MRN letter (or if you are appealing a Tax Credit decision and have
not asked for a mandatory reconsideration the date of your original decision). For example 27/04/2020
/ /
Section 2: About your benefit appeal
Q4. If the date you have entered is over one month from today’s date, briefly explain why your appeal is late.
You need a Mandatory Reconsideration Notice (MRN) before you can appeal all benefit decisions except Tax
Credit decisions. If you do not have an MRN, you should explain why in the space provided below or confirm that
the decision notice you received from the HMRC told you that you did not need one.
Section 2: About your benefit appeal
Q5. Confidentiality
Normally there are only two parties to the appeal, you and HMRC. Clearly HMRC will know all about you.
However, sometimes the dispute you have with HMRC may involve another person.
For example both parents (or another adult) may be claiming Child Benefit. In such cases that other person might
be joined as a party to the appeal.
As that other party has a right to see all the evidence submitted as part of the appeal there will be occasions
when certain types of evidence, such as bills or bank statements are received which will include your home
address. The other party to the appeal will have the right to see this evidence. If, however, you do not want the
other party to know your current address (and they do not already know it), you can ask for your address to be
kept confidential. If you do this, any piece of evidence received relating to you will be scrutinised by HMCTS staff
and will be edited to remove all address details before it is circulated.
Section 2: About your benefit appeal
Q6. I want my home address to be kept confidential.
Yes
No
Options: Yes; No
Section 2: About your benefit appeal
Q7. If you are appealing for yourself, go to section 4
If you are an appointee, go to section 3
Section 3: About the person you are appointed to support
Q8. Section 3: About the person you are appointed to support Use BLOCK CAPITALS
Only fill in this section if you have been officially appointed by HMRC or a court to deal with someone’s
benefits. Put their details in this section.
Section 3: About the person you are appointed to support
Q9. Their details
Mr Mrs Miss Ms Doctor Reverend
Their first name Their last name
Their date of birth (DD/MM/YYYY) Their National Insurance number
/ /
Letters Numbers Letter
Their address
Only enter their address if it is different from yours.
Address line 1
Address line 2
Address line 3
Postcode
Section 4: About your representative (if you have one)
Q10. Section 4: About your representative (if you have one) Use BLOCK CAPITALS
Fill in this section if you have someone helping you with your appeal and you would like them to be your
‘representative’. This might be someone from your local advice centre, law centre or Citizens Advice. It could
also be a carer, friend or family member.
Section 4: About your representative (if you have one)
Q11. Registering a representative means they can:
• help you submit your appeal or prepare your evidence
• act on your behalf (they should ask your permission first)
• see any evidence that is submitted by you or HMRC (including financial evidence)
By entering their details here and signing this form, you are authorising the tribunal to deal with your
representative as well as you, about your appeal.
Provide as much information as you can about your representative. If you want to appoint a representative later,
then you must send us the details in writing to the address at the end of this form.
Mr Mrs Miss Ms Doctor Reverend
First name Last name
Organisation (if they work for one)
Address line 1
Address line 2
Address line 3
Postcode
Email address
Your representative will receive email updates and a link so they can manage your appeal online.
Mobile phone number
Text message updates
Tick this box if your representative would
like to receive text message updates.
Landline number (if they have one)
You should check that your representative
is happy to receive text message updates.
Section 5: The reasons for your appeal
Q12. Section 5: The reasons for your appeal
This is where you explain to the tribunal why you are appealing. The tribunal use this information, and any
evidence that you and HMRC submit, to help them make a decision on your appeal.
HMRC should have explained their decision in the Mandatory Reconsideration Notice or the original Decision
Notice if you are appealing a tax credit appeal.
Write what you disagree with and why you disagree with it.
You can write as much as you want but you must provide at least one reason.
Section 5: The reasons for your appeal
Q13. (Continue your reasons on page 12, if you run out of space.)
Providing evidence to support your benefit appeal
You can include your evidence with this appeal form or you can send it later. You should provide evidence as early
as possible in your appeal, so the tribunal have time to review it before they make a decision.
You do not have to send in evidence. Any evidence you do send will be shared with HMRC and your
‘representative’, if you have one.
Section 6: Your appeal hearing
Q14. Section 6: Your appeal hearing
Your appeal will be decided by the tribunal using the information in this form and any additional evidence you
provide. Information and evidence submitted by HMRC will also be considered.
Or you can also explain your reasons for appealing by taking part in the hearing, by telephone, video or
face-to-face.
Section 6: Your appeal hearing
Q15. I want to take part in the hearing. Go to Section 6a
I do not want to take part in the hearing. Go to Section 9
Options: I want to take part in the hearing.; I do not want to take part in the hearing.
Section 6a: Your telephone, video or face to face hearing
Q16. Section 6a: Your telephone, video or face to face hearing
The type of oral hearing will be at the discretion of the tribunal.
Please select all the suitable options for you to take part in the hearing.
Section 6a: Your telephone, video or face to face hearing
Q17. Telephone (you’ll need somewhere quiet and private to speak). Please give us your preferred telephone
number if different from above.
Video (you’ll need access to a computer or mobile device with a good internet speed and somewhere quiet
and private to speak). Please give us your preferred email address if different from above.
Face to face (you will need to travel to the hearing in person). Go to Section 7
Section 7: Support at your hearing
Q18. Section 7: Support at your hearing Use BLOCK CAPITALS
If you want to take part in the hearing and need support to be arranged by the tribunal, tell us now so we can
arrange it. Any support we provide is free of charge.
You cannot use your own interpreter at the hearing. Provide details below, if you need one.
Section 7: Support at your hearing
Q19. Language interpreter
Language Dialect
Sign language interpreter
Sign language
Hearing loop Accessible hearing room
Any other support that you need the tribunal to arrange which could be for a physical or mental health condition
Section 8: Your availability for a hearing
Q20. Section 8: Your availability for a hearing
Only fill this section in if you want to take part in the hearing.
You should make yourself available for the hearing but if you have dates you cannot attend, then fill them in
below. If you have a representative please also include any unavailability for them.
Section 8: Your availability for a hearing
Q21. I will make myself available for the hearing whenever it’s scheduled. I have no dates to avoid.
Go to section 9
Please note: This includes agreeing to HMCTS offering you a hearing at short notice due to a cancellation
(within 14 days of the date of the hearing). We will call you to confirm if you are available if offering a date
with less than 14 days notice.
I need to tell the tribunal about dates that I cannot attend a hearing (fill them in below)
Only provide dates between 3 and 8 months in the future.
Section 9: Sign and post
Q22. Section 9: Sign and post
The information I have provided in this appeal application is accurate, to the best of my knowledge.
I give the tribunal permission to correspond with my named representative about my appeal (if you gave details
of a representative).
Section 9: Sign and post
Q23. Name (in BLOCK CAPITALS)
The person named on the appeal in section 1
Signature
The person named on the appeal in section 1
Date (DD/MM/YY)
/ /
Section 9: Sign and post
Q24. Where to post your appeal form
You need to send your appeal form and a copy of the Mandatory Reconsideration Notice (MRN) or copy of
original decision notice needed to HM Courts & Tribunals Service.
If you live in England or Wales send your appeal to: If you live in Scotland send your appeal to:
Section 9: Sign and post
Q25. HMCTS Benefit Appeals HMCTS SSCS Appeals Centre
PO Box 12626 PO Box 13150
Harlow Harlow
CM20 9QF CM20 9TT