docs.templates.universal-credit.name

TO: Department for Work and Pensions (DWP)

Universal Credit Service Centre

PART A — APPLICANT DETAILS

Full name: [Applicant Full Name]

Address: [Applicant Address]

Date of birth: [Date of Birth]

National Insurance number: [National Insurance Number, e.g. AB123456C]

PART B — HOUSEHOLD COMPOSITION

[Describe your household, e.g. 'I live alone', 'I live with my partner and two children aged 5 and 8', 'I live with a partner who is also claiming']

PART C — HOUSING SITUATION

[Describe your housing, e.g. 'I rent from a private landlord, £800/month', 'I rent from a housing association', 'I have a mortgage', 'I live with family']

PART D — EMPLOYMENT STATUS

[Describe your employment, e.g. 'I am unemployed and seeking work', 'I work part-time earning £400/month', 'I am unable to work due to illness/disability']

PART E — DECLARATION

I declare that:

1. I am making a claim for Universal Credit under the Welfare Reform Act 2012;

2. The information I have provided is true and complete to the best of my knowledge;

3. I will report any changes in my circumstances promptly as required by the Universal Credit Regulations 2013;

4. I understand that providing false information is an offence under the Fraud Act 2006 and the Social Security Administration Act 1992.

NOTE: This is a template for guidance only. Universal Credit claims must be made online at www.gov.uk/universal-credit. You will need an email address, bank account, and your National Insurance number. Advance payments may be available if you need money before your first payment. Visit www.gov.uk or call the Universal Credit helpline on 0800 328 5644 for assistance.