Claim Child Benefit for one or

more children (CH2)

Applicant details
National Insurance number
PA781016A
Last name
HOYLE
First name
LUCY
Middle names
ELLEN
Date of birth
17 October 1989
Current address
12 ROEBUCK LANE
SALE
CHESHIRE
M33 7SQ
Nationality
British
Always lived in the UK
Yes
HMF or civil servant abroad
No
Marital or civil partnership status
Single
Benefits received
None of these benefits
Telephone number
07740084269
Currently claiming Child Benefit
No

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 Claim Child Benefit for one or more
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Child 1 details Known by any other names

No
Last name
Collier
First name
Millie
Middle names
Ellen
Sex as recorded on child’s birth certificate
Female
Date of birth
10 October 2009
Country of birth registration
England
Birth certificate number
502324233
Child is living with applicant
Yes
Applicant’s relation to child
Birth child
Applicant adopting child via Local Authority
No
Child Benefit claimed for this child
Yes
Previous claimant name
Lucy Ellen Hoyle
Previous claimant address
12 Roebuck Lane
Sale
Cheshire
M33 7SQ

For official use only

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 Claim Child Benefit for one or
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Payment details
Wants to be paid Child Benefit
Yes
Child Benefit payment frequency
Weekly
Paid into existing bank account
No
Sort code
110013
Account number
00975340
Account holder
Applicant
Name of bank or building society
Halifax
Name on account
Lucy Ellen Hoyle

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 Claim Child Benefit for one or
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Additional information
I haven’t claimed for many years as I didn’t realise I was eligible to get this benefit as well as
working full time.

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 Claim Child Benefit for one or more
children (CH2)

Declaration
I declare that the information I’ve given on this form is correct and complete. If I give
X information which I know is not correct or complete, you may take action against me.
I’ll tell you about changes to my circumstances when they happen and understand I
could be overpaid and may have to pay money back if I do not.

Signature

Date
Day Month Year

D D / M M / Y Y Y Y

For official use only

Corres Traced CLI Date claim received

Corres Traced CLI

Document(s) returned
Birth certificate Normal
Passport Recorded
Other Registered

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 Claim Child Benefit for one or more
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What to do now
After you have printed this form and signed and dated the Declaration, return the form to:

Child Benefit Office (GB)

Washington
NEWCASTLE UPON TYNE
NE88 1ZD

You’ll need a stamp for the envelope; make sure you pay the correct postage.

You’ll need a stamp on the outside of your envelope to post your form to us, don’t send the
stamp to us separately. Make sure you pay the correct postage.

What happens next

We’ll review your claim and write to tell you if you can get Child Benefit and how much you’ll
get.

If you need further assistance with your claim, contact the Child Benefit helpline.

Telephone: 0300 200 3100

Outside UK: +44 161 210 3086

You can also use Relay UK if you cannot hear or speak on the phone: dial 18001 then 0300
200 3100.