Application Education Sanford House
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)
National Insurance Number of Claimant
Last name (parent/carer) First name Mr/Mrs/Miss/Ms/Other
Telephone number Relationship to pupil (mother, father, carer, etc.)
Please list below all children in attendance at school or other educational establishment.
LAST NAME FIRST NAME MALE/FEMALE NAME OF SCHOOL
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
Initials School notified
*Delete as appropriate
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.