Retirement £ £ Job Seeker’s £ £ Pension Allowance Pension Credit Statutory Sick Pay £ £ £ £ Guarantee Credit Pension Credit £ £ Industrial Injuries £ £ Savings Credit Benefit Income Support £ £ War Disablement £ £ Pension DLA (Care) or £ £ War Widows £ £ PIP (Daily Pension Living) DLA (Mobility) £ £ State Widow’s £ £ or PIP (Mobility) Pension or Widowed Mother’s Allowance Attendance Carers Allowance £ £ £ £ Allowance ESA / Incapacity £ £ Working Tax £ £ Benefit Credits Severe £ £ Child Tax Credit £ £ Disablement Allowance Statutory Benefit or £ £ £ £ Maternity Pay or Guardians Maternity Allowance Allowance Other (please state) £ £ TOTAL £ £ Does anyone claim Carers Allowance for looking after you? Yes / No If who? ____________________________________________ yes,
Retirement Pension £ £ Job Seeker’s Allowance £ £ Pension Credit Guarantee Credit £ £ Statutory Sick Pay £ £ Pension Credit Savings Credit £ £ Industrial Injuries Benefit £ £ Income Support £ £ War Disablement Pension £ £ DLA (Care) or PIP (Daily Living) £ £ War Widows Pension £ £ DLA (Mobility) or PIP (Mobility) £ £ State Widow’s Pension or Widowed Mother’s Allowance £ £ Attendance Allowance £ £ Carers Allowance £ £ ESA / Incapacity Benefit £ £ Working Tax Credits £ £ Severe Disablement Allowance £ £ Child Tax Credit £ £ Statutory Maternity Pay or Maternity Allowance £ £ Benefit or Guardians Allowance £ £ Other (please state) £ £ TOTAL £ £ Does anyone claim Carers Allowance for looking after you? Yes / No If yes, who? ____________________________________________
Charging-Policy_-2016.docx