Application Form For Free School Lunches

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Application Form For Free School Lunches Powered By Docstoc
					                      Application                       Education                Sanford House
                                                                                 Sanford Street
                      Form For Free                                              Swindon SN1 1QH

                      School Lunches                                             Tel: 01793 465867/ 465790/465791

Entitlement arises where parents/carers are in receipt of:
. Income Support
. Income Based Jobseekers Allowance
. Support under Part VI of the Immigration and Asylum Act 1999.
. Child Tax Credit, who do not receive Working Tax Credit AND who have an annual taxable
  income of less than £13,910.

Please tick box if this is a new application (only one application is required for all children)

Section A
National Insurance Number of Claimant

Last name (parent/carer)                           First name                           Mr/Mrs/Miss/Ms/Other

Home address


Telephone number                       Relationship to pupil (mother, father, carer, etc.)

Please list below all children in attendance at school or other educational establishment.

                                                            DATE OF
   LAST NAME             FIRST NAME      MALE/FEMALE                        NAME OF SCHOOL

Section B
PLEASE NOTE: Applications will not be accepted without proof. If you do not have any recent
proof (dated within last three months), please ask the Department for Work & Pensions (DSS) -
to endorse your claim on the back of this form.
If you are claiming under part VI of the Immigration & Asylum Act 1999, tick box.
I certify that the information given on this application form is correct to the best of my knowledge and
belief. I undertake to notify the Education Department immediately of any change in the payment of

Signature of applicant                                                  Date
Section C (for office use only)

Income Support confirmation - copy attached*
Income Based JSA letter/DWP stamp on form - copy attached*
TC 602 Tax Credit Award notice - copy attatched*           From                        To

Received                                                        Entered on system
                                                                Parent notified
Initials                                                        School notified

*Delete as appropriate

Section D
If you do not have any documentary evidence, you may ask the Department for Works &
Pensions (DSS) - to complete this section.

I certify that the applicant Mr/Mrs/Miss/Ms/Other

National Insurance Number
is currently in receipt of:

    (A) Income Support
    (B) Income Based Job Seekers Allowance

Signature                                                         DWP stamp


Should you require information in another format, please contact Customer Services on (01793) 463725

The completed form and proof should be returned to the school or to the Admissions Team,
Sanford House, Sanford Street, Swindon SN1 1QH.