Income Support or ESA (Income Related) Job Seekers Allowance (Income Based not Contribution Based) – Child Tax Credit, but are not entitled to Working Tax Credit and your annual income (as assessed by the Inland Revenue) does not exceed £16,190.00 Support Part VI of the Immigration & Asylum Act 1999 The Element of Pension Credit ‘Guaranteed IN ADDITION ONE OR MORE OF THE FOLLOWING CONDITIONS MUST APPLY AND EVIDENCE MUST BE PROVIDED. Please indicate are applicable:- There has been a fire, theft or flood Homeless families e.g. parent leaving home due to domestic violence – Medical condition e.g. obesity, extreme growth, child with enuresis or soiling problem – Bereavement loss of parent – Reconstituted families e.g. where a child returns to live with one parent, having lived with the other, and financial – difficulties arise (child may arrive with no clothing) Conditions of extreme poverty e.g. situations where families are at risk of being made homeless, high debts etc – Move of school due to supported transfer following PRRP process (Permanently Excluded pupil) HOW TO APPLY Read and sign the certificate on the front of this form. Complete the boxes overleaf with your details and your children’s details. If you need help to complete this part of the form, telephone the Children and Young People Information Service on 01454 868008. Attach proof that you are entitled to the Essential Clothing Grant. We accept: a letter from Jobcentre Plus showing that you receive Income Support or Job Seeker’s Allowance (Income Based) and dated within the last three months a copy of your TC602 renewal notice for 2017 2018 (valid if you have an income under £16,190.00 and – DO NOT receive Working Tax Credit). a copy of your Credit M1000 Award Notice’ showing that you are in receipt of the ‘Pension ‘Guaranteed element of Pension Credit. a copy of your letter (listing all children) from the National Asylum Support Service (NASS) confirming that you receive support under Part VI of the Immigration and Asylum Act 1999. A Bank Statement. Not more than three months old, showing your name, address and which benefit you are receiving. Evidence for the required additional conditions. Return this form to: CHILDREN AND YOUNG PEOPLE INFORMATION SERVICE, SOUTH GLOUCESTERSHIRE COUNCIL, PO , Civic Centre, High Street, Kingswood, , BS15 0DQ Telephone: 01454 868008, email:
Income Support or ESA (Income Related) Job Seekers Allowance (Income Based – not Contribution Based) Child Tax Credit, but are not entitled to Working Tax Credit and your annual income (as assessed by the Inland Revenue) does not exceed £16,190.00 Support Part VI of the Immigration & Asylum Act 1999 The ‘Guaranteed Element of Pension Credit IN ADDITION ONE OR MORE OF THE FOLLOWING CONDITIONS MUST APPLY AND EVIDENCE MUST BE PROVIDED. Please indicate are applicable:- There has been a fire, theft or flood Homeless families – e.g. parent leaving home due to domestic violence Medical condition – e.g. obesity, extreme growth, child with enuresis or soiling problem Bereavement – loss of parent Reconstituted families – e.g. where a child returns to live with one parent, having lived with the other, and financial difficulties arise (child may arrive with no clothing) Conditions of extreme poverty – e.g. situations where families are at risk of being made homeless, high debts etc Move of school due to supported transfer following PRRP process (Permanently Excluded pupil) HOW TO APPLY Read and sign the certificate on the front of this form. Complete the boxes overleaf with your details and your children’s details. If you need help to complete this part of the form, telephone the Children and Young People Information Service on 01454 868008. Attach proof that you are entitled to the Essential Clothing Grant. We accept: a letter from Jobcentre Plus showing that you receive Income Support or Job Seeker’s Allowance (Income Based) and dated within the last three months a copy of your TC602 renewal notice for 2017 – 2018 (valid if you have an income under £16,190.00 and DO NOT receive Working Tax Credit). a copy of your ‘Pension Credit M1000 Award Notice’ showing that you are in receipt of the ‘Guaranteed element of Pension Credit. a copy of your letter (listing all children) from the National Asylum Support Service (NASS) confirming that you receive support under Part VI of the Immigration and Asylum Act 1999. A Bank Statement. Not more than three months old, showing your name, address and which benefit you are receiving. Evidence for the required additional conditions. Return this form to: CHILDREN AND YOUNG PEOPLE INFORMATION SERVICE, SOUTH GLOUCESTERSHIRE COUNCIL, PO , Civic Centre, High Street, Kingswood, , BS15 0DQ Telephone: 01454 868008, email:
Application-for-essential-clothing-grant-201718.docx