Please tell us your marital status:
Single
Married
Widowed
Living with a Partner
Seperated
Divorced
Do you usually live in the UK:
YES
NO
Please tell us the Country you usually live in:
Country:
If you came to live in the UK within the last 3 months please tell us when
you arrived:
--Day--
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
--Month--
January
February
March
April
May
June
July
August
September
October
November
December
--Year--
2010
2009
What is your Nationality:
Are you Subject to immigration control:
NO
YES
Have you been granted your current immigration status in the last 3 months:
NO
YES
Please tell us the date your immigration status was granted:
--Day--
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
--Month--
January
February
March
April
May
June
July
August
September
October
November
December
--Year--
2010
2009
Please tell us your Home Office reference number:
Ref No.:
Are you, or your partner if you have one, a UK Crown Servant posted overseas:
NO
YES
In the last 3 months, were you or your partner employed in Switzerland
or a country in the European Economic Area (not including the UK):
NO
YES
Are you or your partner currently employed in Switzerland
or a country in the European Economic Area (not including the UK):
NO
YES
In the last 3 months, did you or your partner receive a benefit from Switzerland
or a country in the European Economic Area (not including the UK):
NO
YES
Are you or your partner currently receiving benefit from Switzerland or
a country in the European Economic Area (not including the UK):
NO
YES
Section 2 - Your Partners Details
Do you have a partner:
NO
YES
What is your Partner's Nationality:
Nationality:
Is your partner already getting, or waiting to hear if they can get Child
Benefit for any children (Select NO if you dont have a partner):
NO
YES
What is your Partner's:
Full Name:
National Insurance Number:
Child Benefit Number:
CHB
Full name of the eldest child your partner
gets Child Benefit for (or is waiting to hear about Child Benefit for):
What is this child’s date of birth:
--Day--
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
--Month--
January
February
March
April
May
June
July
August
September
October
November
December
--Year--
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Section 3 - Children you want to Claim Child Benefit
for
Do not tell us about any children you already get Child Benefit
for. Please enter the name exactly as shown on the child’s birth or
adoption certificate.
1st Child
Forename(s):
Surname Name:
Childs Sex:
Male
Female
What is this child’s date of birth:
--Day--
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
--Month--
January
February
March
April
May
June
July
August
September
October
November
December
--Year--
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Do you want to claim for a 2nd Child :
NO
YES
What is your Childs's:
Forename(s):
Surname:
Sex: Male Female
Date of birth:
--Day--
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
--Month--
January
February
March
April
May
June
July
August
September
October
November
December
--Year--
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Do you want to claim for a 3rd Child :
NO
YES
What is your Childs's:
Forename(s):
Surname:
Sex: Male Female
Date of birth:
--Day--
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
--Month--
January
February
March
April
May
June
July
August
September
October
November
December
--Year--
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Do you want to claim for a 4th Child :
NO
YES
What is your Childs's:
Forename(s):
Surname:
Sex: Male Female
Date of birth:
--Day--
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
--Month--
January
February
March
April
May
June
July
August
September
October
November
December
--Year--
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Has anyone else ever claimed Child Benefit for any of the children you
want to claim for:
NO
YES
What is the name of the person who claimed (if known):
Full Name:
What address was the claim made from (if known):
House Number or Name:
Street:
Town:
County:
Postcode:
The Child Benefit number (if known):
CHB
Have any of the children you want to claim for used a different name
from the one they have now, or
from the one shown on their birth or adoption certificate?
NO
YES
Please tell us the childs current & previous names:
Child 1 Current Name:
Child 1 previous Name:
Child 2 Current Name:
Child 2 previous Name:
Child 3 Current Name:
Child 3 previous Name:
Child 4 Current Name:
Child 4 previous Name:
Are any of the children you want to claim for living at a different address
to yours? Please note, this includes children living outside the UK, even
if they are living with another family member:
NO
YES
Please tell us the names of the children not living at
your address:
Child's name:
Child's name:
Child's name:
Child's name:
Have any of the children you want to claim for lived at a different address
to yours in the last 3 months? Please note, this includes children who have
lived outside the UK, even if they were living with another family member:
NO
YES
Please tell us the names of the children and the date they came to live with you:
Child 1 name:
Date:
--Day--
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
--Month--
January
February
March
April
May
June
July
August
September
October
November
December
--Year--
2010
2009
Child 2 name:
Date:
--Day--
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
--Month--
January
February
March
April
May
June
July
August
September
October
November
December
--Year--
2010
2009
Child 3 name:
Date:
--Day--
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
--Month--
January
February
March
April
May
June
July
August
September
October
November
December
--Year--
2010
2009
Child 4 name:
Date:
--Day--
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
--Month--
January
February
March
April
May
June
July
August
September
October
November
December
--Year--
2010
2009
Are you including any children on this claim that are not your own? Please
note, stepchildren and children you have legally adopted count as your own:
NO
YES
If you plan to adopt any of the children, Please tell us the names of the children:
Child 1 name:
Child 2 name:
Child 3 name:
Child 4 name:
If any of the children you want to claim for are not your own, and you are not planning to adopt them, please tell us:
1st Child Name:
Previous Surname(s):
Childs Mothers Name:
Childs Fathers Name:
2nd Child Name:
Previous Surname(s):
Childs Mothers Name:
Childs Fathers Name:
3rd Child Name:
Previous Surname(s):
Childs Mothers Name:
Childs Fathers Name:
4th Child Name:
Previous Surname(s):
Childs Mothers Name:
Childs Fathers Name:
If you are getting Child Benefit already, is it paid directly into an account:
(select NO if you are not getting Child Benefit)
NO
YES
Please tell us anything else you think we might need to know, for example
any other names you have been known by
other children you want to claim for that you have not told us about
If you are getting Child Benefit already, do you want it paid directly
into an account:
(select NO if you are not getting Child Benefit)
NO
YES
If you are getting Child Benefit already, are you unable to open an account:
(select NO if you are not getting Child Benefit)
NO
YES
The Child Benefit Office will contact you regarding this. Please tell us anything else you think we might need to know, for example:
any other names you have been known by
other children you want to claim for that you have not told us about
If you are claiming Child Benefit for the first time, or are claiming again
after Child Benefit has stopped, do you want your Child Benefit paid directly
into your account?:
NO
YES
If you are claiming Child Benefit for the first time, or are claiming again
after Child Benefit has stopped, would you like more information about opening
an account:
NO
YES
The Child Benefit Office will contact you regarding this. Please tell us anything else you think we might need to know, for example:
any other names you have been known by
other children you want to claim for that you have not told us about
If you are claiming Child Benefit for the first time, or are claiming again after Child Benefit has stopped, Have you applied, or are you going to apply for an account, but do not yet have your account details:
NO YES
The Child Benefit Office will contact you regarding this. Please tell us anything else you think we might need to know, for example:
any other names you have been known by
other children you want to claim for that you have not told us about
If you are claiming Child Benefit for the first time, or are claiming
again after Child Benefit has stopped, Are you unable to open an account:
NO
YES
The Child Benefit Office will contact you regarding this. Please tell us anything else you think we might need to know, for example:
any other names you have been known by
other children you want to claim for that you have not told us about
Please read these terms and conditions carefully before clicking the “SUBMIT CLAIM” button and ordering this Service from our Website. You should understand that by ordering this Service, you agree to be bound by our Apply Online Terms and Conditions . Further, you acknowledge and accept that your subscription to this Services through our Website is also subject to and governed by the terms of our websites’ respective Terms of Use and Data Protection Notice and Privacy Policy and Acceptable Use Policy which form part of our Apply On-line Terms and Conditions.
I have read the Apply On-line Terms and Conditions , also detailed below,
and read the
Data Protection Notice and Privacy Policy . By reading these and clicking on the
“I Accept” button indicating that I agree to be bound by these terms.
I Accept
I understand that as part of the Apply Online Terms and Conditions , I agree to pay £9.95+VAT (£11.69) to Digital Select before I receive this service.
I Accept