Date of Admission (if applicable) To: Hospital Residential / Nursing Home Please tell us the people living at your address: DATE BENEFITS NAME OF RELATIONSHIP Pension Pension AA DLA Credit Credit Care/PIP BIRTH TO YOU Guarantee Savings Daily Credit Credit Living £ £ £ £ £ £ £ £ £ £ £ £ £ £ £ £ Are any of the above registered blind, if so who? _____________________________________
Date of Admission (if applicable) To: Hospital Residential / Nursing Home Please tell us the people living at your address: NAME DATE OF BIRTH RELATIONSHIP TO YOU BENEFITS Pension Credit Guarantee Credit Pension Credit Savings Credit AA DLA Care/PIP Daily Living £ £ £ £ £ £ £ £ £ £ £ £ £ £ £ £ Are any of the above registered blind, if so who? _____________________________________
Charging-Policy_-2016.docx