jobseeker’s allowance - whatdotheyknow · pdf filenotes 2: how much you could get notes...

Jobseeker’s AllowanceClaim form for single people

JSA1S 10/13

How to claimThe best way to claim is online. You may get your benefit more quickly.Visit www.gov.uk/jobseekers-allowance/how-to-claim

Or claim by phone on 0800 055 6688.

If you have speech or hearing difficulties, contact us by textphone on0800 023 4888. Lines are open Monday to Friday 8.00am to 6.00pm.

Calls to 0800 numbers are free from BT landlines and most mobiles but youmay have to pay if you use another phone company.

Please read the notes before you fill in this form. They explain how to choose whether to claim

or Jobseeker’s Allowance.

What you decide is important because it affects which parts of this form youneed to fill in.Do not be put off because the form looks long. It will not take you as long asyou think to fill in. You will not usually have to answer all the questions.

If you need any help to fill in this form, get in touch with Jobcentre Plus.This form is available in Welsh.

income-based contribution-based

This is a claim form for single people. Do not fill in this form if you have a partner, or children or qualifying young personswho live with you. Please contact us before your interview to get the correct form.

Notes 1

You must be ● capable of work● available for work● actively seeking work.

You must also enter into aJobseeker’s Agreement which sets outwhat you are going to do to find work. You can’t normally get Jobseeker’sAllowance if you regularly work16 hours or more a week, on average.You must tell us if you do any work.Any money you earn may affect yourbenefit.

How do I qualify?

How much could I get?

Which parts form JSA1(S)do I fill in?

If you are not sure what todo...

Fill in all parts of the form that apply to you.

Contribution-based Jobseeker’sAllowance is based on how muchNational Insurance you have paid inthe last two relevant tax years. Generally, self-employedcontributions will not help you qualifyfor contribution-basedJobseeker’s Allowance.If you do not qualify on your UnitedKingdom (UK) NI contributions andyou have worked outside the UK,this period of employment may helpyou qualify.

Ask for form JSA31.

Go to How much you could get onNotes 2. We may reduce the amount ifyou get● other social security benefits● earnings from part-time work● a personal or occupational

pension● a public service pension.But it is not affected by savings.

Fill in the answer boxes on pages 1to 8. Then go to Part 15 How wepay you.

You may get income-basedJobseeker’s Allowance if● you have savings of £16,000 or less● the money you have coming in

each week is less than the amountof Jobseeker’s Allowance youcould get.

Go to How much you could get onNotes 2. The amounts you get may be reducedif you have● savings over £6,000● money coming in each week.

This could be – earnings from part-time work– other social security benefits– personal or occupational

pensions.

Fill in all parts of the form that applyto you to claim income-basedJobseeker’s Allowance.

Contribution-based Jobseeker’sAllowance is a flat-rate amount foryou as an individual. You could get it for up to 6 months.

Income-based Jobseeker’s Allowanceis money for● you ● certain housing costs● special needs. For example, if you

have a disability.Claim this ● if you think you will not qualify for

the contribution-based part or thatit will not be enough to live on

● to get help with your housing costs.

Jobseeker’s Allowance is a socialsecurity benefit for people who areseeking work.If you are under 18, special ruleswill apply.Jobseeker’s Allowance has 2 parts

Income-based

Contribution-basedEveryone must give usthe information weneed for this.

You must choosewhether or not to claimthis.

What is Jobseeker’sAllowance?

if you have paid enough NationalInsurance contributions

if you do not have enough money coming in

Contribution-based Income-based

Notes 2: How much you could get

Notes 3: More information

Help with housing costsIf you claim income-based Jobseeker’s Allowance andhave a mortgage or home loan you may be able to getextra for the interest on your mortgage or home loan. To claim Housing Benefit complete form HCTB1 and sendit to your local council. To claim a reduction in Council Taxcontact your local council direct.If you claim contribution-based Jobseeker’s Allowanceyou may still get help with rent and/or a reduction inCouncil Tax from your local council. Contact your localcouncil direct.Under the support for Mortgage Interest rules whichcame in on 5 January 2009 for new claims, if you receivehelp with your housing costs as part of your Jobseeker’sAllowance, we will only pay your housing costs for up toa maximum of two years. Ask Jobcentre Plus for moreinformation.If you are worried about your mortgage you can contactthe National Homelessness Advice Service. You can get aleaflet from their website atwww.nhas.org.uk/publications.htmFor more information and advice about mortgages go tothe Money Advice Service website atwww.moneyadviceservice.org.uk

If you are ill or disabledIf you are under the age you can get Pension Credit andare ill or disabled, you may wish to claim Employmentand Support Allowance. If you want help to decide whichbenefit to claim, get in touch with Jobcentre Plus.The minimum age you can get Pension Credit is rising,linked to the changes to women’s State Pension age. For more information visitwww.gov.uk/calculate-state-pension

Partners and childrenWe use partner to mean● a person you are married to or a person you live with as

if you are married to them, or● a civil partner or a person you live with as if you are

civil partners.We use child to mean a person aged under 16 who you aregetting Child Benefit for.We use qualifying young person to mean a person aged 16,17, 18 or 19 who you are getting Child Benefit for.

Help and adviceIf you want general advice and information aboutJobseeker’s Allowance or social security benefits● get in touch with Jobcentre Plus. You can find the phone

number and address in the business section of thephone book. Look under Jobcentre Plus

● get in touch with an advice centre, like a Citizens AdviceBureau, or

● visit www.gov.uk

For more information about Jobseeker's Allowance rates we use,please ask for our leaflet Benefit and Pension rates. This is availablefrom Jobcentre Plus. You can also view the Jobseeker's Allowancebenefit rates by visiting the DWP website.The Jobseeker’s Allowance rates usually change each April.

Your surname

Your other names

Postcode

Any other surnames you havebeen known by

Code NumberHome phone number

Address

Date of birth / /

National Insurance (NI) number

Part 1: About your claim

Letters Numbers Letter

If you do not claim income-based Jobseeker’s Allowance now, but then askfor it at a later date, we will normally only pay it from that later date.

Do you have any children or qualifyingyoung persons living with you?

Do you want to claim Jobseeker’s Allowance?Tick Yes if you are not sure.

income- based

Yes

No Only fill in the answer boxes on pages 1 to 8 thengo to Part 15 How we pay you.You must fill in all parts of the form that apply to you.

Do not fill in this form. Ask us for form JSA1 straight away.Yes

No

Part 2: About you

Title Mr Mrs Miss Ms Other title

Code NumberMobile phone number

Code NumberDaytime phone number, if different

What date do you want to claimJobseeker’s Allowance from?

We will need more information if the date you put is before thedate you first got in touch with us.

/ /

Have you been on jury servicein the last 12 weeks?

If this is not your permanent addressbut a contact address, tick this box.

Please bring to your interview the letter you were given bythe court when your jury service ended. This will tell ushow long you were on jury service.

Yes

No

Backdated form issued? No Yes Effective (TAM) date / /For our useJSA1(S) 10/13

Part 2: About you continued

Yes

No

Yes

No

2

widowed or survivingcivil partner

single divorced orcivil partnership dissolved

separatedTick all the boxes that apply to you.If you tick more than one box, please tellus why in Part 16 Other Information.

/ /

Date became widowed orsurviving civil partner

If you have separated from a person who used to be your partner,in the last six months, we need some information about them.

Their surname

Their other names

Their date of birth / /

Postcode

Their address

When did you separate? / /

Is this separation temporary?

Tell us about this in Part 16. For example, the reason forthe separation and how long you expect it to last.

Has this person gone abroad?

Have they gone abroad permanently?

Yes

No

Have you worked or claimed benefitoutside the United Kingdom in thelast 4 years? By United Kingdom wemean England, Scotland, Wales andNorthern Ireland.

Yes

No

Which country or countries did youwork or claim in?

Are you importing unemploymentbenefit from that country?

Fill in the rest of this form.

Yes

No

Do not fill in the rest of this form. Give us this form andany documents you have about your benefit from abroad.

What is your nationality?

Please tick all the boxes that describewhat you did while you were abroad.

Employed by aforeign employerClaimed UKbenefit abroad

Self-employed

Employed by a UKemployer

Tell us when: from / / to / /

HRT – see guidance Importing benefit case? No Yes

Do you have any restrictions imposedby the Home Office on your right towork in this country? We will need to see your passport and any Home Office

documents such as letters or forms concerning theserestrictions when you attend your interview at theJobcentre. If you do not bring these documents with you,you may not be able to continue with your claim.

Yes

No

Please go to Part 4 About work in the last 6 months.

Please tell us about this below.

Employer’s name

Employer’s phone number

About work

Part 3: About work you do now

Yes

No

Postcode

Code Number

3

We need to know about any work you ● are doing now● have done in the last 6 months.We need to know about any● work for an employer or self-employed work● full-time or part-time work

● permanent or casual work● unpaid work or paid work● voluntary work● work as a company director● time spent on Work-Based Training for Young People,

Skillseekers in Scotland, or Training for Work in Scotland.

Are you working at the moment?If you do voluntary work or you aretemporarily absent from work, stilltick Yes. You could be absent fromwork because of jury service orshort-time working.

Date the work started

Number of hours a week usually worked hours

/ /

Employer’s address

Your job

Do you get paid for the work you donow? If you get anything in return forworking, tick Yes. This could be thingslike accommodation or food.

Please bring the last five payslips to your interview,if you have them.

Yes

No

Is the work you do voluntary work?

Can you choose whether or notto be paid for the work?

Yes

No

Yes

No

Are you self-employed or acompany director? Yes

No

Please fill in the form B16 we gave you.

For our useB7 issued? No Yes

VW1 issued? No Yes

Payslips verified? No Yes B16 issued?

A15C issued?

No Yes

No Yes

Dates you worked

Why did you stop work?

Part 4: About work in the last 6 months

Yes

No

Last employer’s address

Last employer’s phone number

Postcode

Code Number

4

Have you had a job which ended inthe last 6 months?If you are not working at the moment,but you have been working as a supplyteacher or for an employment agency,still tick Yes.

Go to Part 5 About payments from work.

Please tell us about the last job.

Last employer’s name

Your job

Were you self-employed ora company director? Yes

No

Please fill in the form B16 we gave you.

Have you done any other workin the last 6 months? Yes

No

Please tell us about this in Part 16 Other information.

Part 5: About payments from work

We need to know about any payments you have received in the last 6 monthsor expect to receive because a job has ended.We mean payments to do with work but not for work done. This could be ● any payment by way of retainer ● a pension refund.

ES85 required? No Yes

B16 issued? No Yes

ES84JP issued? No YesFor our use

from / / to / /

Please tell us who made the paymentYes

NoHave you received or do youexpect to receive any paymentlike this because a job ended?

Part 5: About payments from work continued

Part 6: About pensions

Postcode

5

Please bring your P45 to your interview.

This could be an occupational pension, a personal pensionor a retirement annuity. Include payment from the Armed Forces CompensationScheme as an occupational pension. This could includepensions that you have built up when you worked abroad.Do not tell us about state pensions here.

Tick Yes if you get ● regular pension payments● an annual compensation payment from a previous job● lump sum payments from an occupational or

personal pension. These could be paid yearly.● payments from the Pension Protection Fund● Financial Assistance Scheme payments.

Go to Part 7 Education and training.Are you receiving a pension orexpecting to receive a pension inthe next 3 years? Yes

No

When did the pension start or whenwill it start?

Who pays or will pay the pension?

Their address

/ /

ES85 required? No YesPension details verified? No YesFor our use

Yes

No Please tell us below how you supported yourself whenyou were not working or not receiving benefit.Go to Part 6 About pensions.

Have you worked for thewhole of the last 6 months?

Part 6: About pensions continued

Yes

No

£

Postcode

Yes

No

Yes

No

6

Please bring proof of the pension to your interview. For example, a pay statement showing details of the pension.

Did you choose to take regular incomefrom the pension scheme instead ofbuying an annuity?

Pension or policy reference number

How much is the pension?

How often is or will the pensionbe paid?

every weeks/months/year

If you have more than one pension, please tell us in Part 16 Other information.

Was this the maximumincome you could take? Yes

No

Part 7: Education and training

Have you attended a course ofeducation or training in the last6 months?If the course is continuing, still tick Yes.

Name of the course ortraining programme

Was the course education or training?

Go to Part 8 About benefits and tax credits.


Name and address of school, trainingcentre, college or university

Number of hours a week

Start date and official end date ofthe course of education or training

Date of final examination

Are you getting, or did you get, anyfunding in relation to your studiesfrom a local authority or department,or any other source? You do not need to tell us about aJobcentre Plus Allowance Payment.

If the course is continuing ● please fill in the form ES567SJP we gave you, and● if you want to claim income-based Jobseeker’s Allowance,

please fill in the form ST1 we gave you as well.

hours

from / / to / /

/ /

ST1 issued? No Yes ES567SJP issued? No Yes

Education Training

For our use

Part 7: Education and training continued

7

Yes

NoDo you intend to continue in trainingor full-time study in the future?For example, a governmentprogramme such as Work-BasedTraining for Young People, Skillseekersin Scotland, Work-Based Learning inWales, Training for Work in Scotland ora college course.

When will it start or when did it start?

/ /

Part 8: About benefits and tax credits

● Universal Credit● War Pension● War Pension Mobility Supplement● Widow’s Pension● Widowed Mother’s Allowance● Widowed Parent’s Allowance● any benefits paid by other countries● any other social security benefit.Tax credits● Working Tax Credit● Child Tax Credit.

● Attendance Allowance● Bereavement Allowance● Disability Living Allowance● Employment and Support

Allowance● Incapacity Benefit● Industrial Death Benefit● Industrial Injuries Disablement

Benefit● Income Support

● Maternity Allowance● Motability or any other help with

mobility problems, for example,an invalid vehicle

● Pension Credit● Personal Independence Payment● Reduced Earnings Allowance● State Pension● Severe Disablement Allowance● Unemployability Supplement

Please read this list of benefits and tax credits and answer the questions.

Are you entitled to Carer’s Allowance?If you are not paid any Carer’s Allowancebecause you are getting another socialsecurity benefit, tick Yes.You may get more Jobseeker’sAllowance, even if you are entitled toCarer’s Allowance but not getting it.

Are you getting or waiting to hearabout any other benefits or tax credits? Please tell us which benefit or tax credits.

Yes

No

Yes

No

Yes

No

Postcode

8

Part 8: About benefits and tax credits continued

Do you get War Widow’s orWar Widower’s Pension?

Reference number

Does this include a Ministry of Defence(MoD) special allowance? Please bring the award notice to your interview.

Does anyone care for youon a regular basis?

Do they get Carer’s Allowance forcaring for you? Tick Yes if they have claimedCarer’s Allowance and are waitingto hear about it.

Their address

Their name

Go to What to do now below.

Please tell us about them.

Yes

No

Yes

No

Yes

No

What to do now

If you are claiming contribution-based Jobseeker’s Allowance

If you are claiming income-based Jobseeker’s Allowance

If you are sure you do not want to claimincome-based Jobseeker’s Allowance, go toPart 15 How we pay you. If you are not sure, read the notes at the frontof this form to help you decide. If you are still not sure, please answer all thequestions on the form that apply to you andyour partner, if you have one.

If you do not claim income-based Jobseeker’sAllowance now, but then ask for it at a later date,we will normally only pay it from that later date.

If you ticked the Yes box on page 1 to claimincome-based Jobseeker’s Allowance, we needmore information.Go to Part 9 About bank and building societyaccounts, savings and property.

For our use MOD Special Allowance award notice attached? No Yes

9

Part 9: About bank and building society accounts, savings and property

We need to know about any money, savings, investments and propertyin the United Kingdom (UK) or abroad which belong to you. By the UK we mean England, Scotland, Wales and Northern Ireland.

Do you have any of the following?Please tick No or Yes for every item in the list.Tell us about accounts even if they are not in credit.

Please bring proof of this to your interview.

Please bring proof of all these savings to your interview if the total amountis £5,500 or more. For example, a bank statement issued within the lastmonth or a savings account book updated within the last month.

If this amount is currently less than£5,500, has it been more than£5,500 during the last 6 months?

No

Yes

Number of shares

Name of company

Bank accounts – including currentaccounts

Building society accounts – includingcurrent accounts

Post Office® accounts

National Savings & Investmentsaccount

Premium bonds

Unit trusts, ISAs, PEPs and otherinvestments

Money from the sale of a house

Money saved for something

Money or property held in trust

Money from a redundancy payment

Income Bonds or Capital Bonds

Any other money or savings of anykind including online accounts suchas Pay Pal

No

How much are your savingsworth in total?

£

Yes Amount

Shares – tell us about any othershares in Part 16 Other information.

£

£

£

£

£

£

£

£

£

£

£

£

£

For our use Proof of savings > £5,500 verified? No Yes

Property or land – details provided andverified?

No Yes

NSC attached? No Yes

10

Part 9: About bank and building society accounts, savings and property continued

Apart from the home you live in, do youown or jointly own any other propertyor land in the UK or abroad?Tick Yes if the property or land is● on a mortgage or loan, or● jointly owned.

Have you sold any property otherthan where you lived during thelast 6 months?

What is the address of the property or land?

Please bring proof of this to your interview.

Who does this property or land belong to?

Have you received a lump sumpayment in the last 52 weeksbecause of a personal injury?We do not need to know aboutlump sum payments held in aPersonal Injury Trust. How much?

On what datedid you get it?

£

Postcode

/ /

No

Yes

No

Yes

No

Yes

11

Part 10: About other money

For our use


If you have separated from aperson who used to be your partner,will they continue to pay anythingtowards the mortgage?

Who will they make payments to?

When will you get this payment?

How often will this be paid?

How much do you expect to get?

Please tell us about the last payment you received.

Have they stopped paying towardsthe mortgage?

When was this paid?

How much did you get?

SSP/SMP verified? No Yes

Does anyone pay money tosomeone else on your behalf?For example, someone might payyour gas or electricity bills.

Who pays this money?

What date is the next payment due?

How much money is paid andhow often?

What is this money paid for?

£ every weeks / months / year

If more than one thing is paid on your behalf,please tell us in Part 16 Other information.

To you Direct to your lender

/ /

£

/ /

£

/ /

Do you get rent from anyone forrooms or property?For example, from boarders,lodgers, tenants or subtenants.

£ every weeks / months

Who pays the rent?

How much do they pay and how often?


Does this include any moneyfor heating?

Does this include any money for meals?

If you need to tell us about more than one rent,please tell us in Part 16 Other information.

/ /

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

12

Part 10: About other money continued

Are you currently gettingReturn to Work Credit?

Did you get Return to Work Creditin the last 3 months? What was the date of the last payment?

/ /

We need to know about any other money you have coming in. Money coming in includes● maintenance paid voluntarily● maintenance paid because of a court order● maintenance paid because of a child maintenance assessment● money from a trust fund● any training allowance – for example

– Work Based Learning (Wales)– Training for Work (Scotland)– Work Based Training for Young People– Skillseekers (Scotland)

Do you have any other moneycoming in?Include here Child Benefit, Child BenefitLone Parent Rate and child maintenance.

Where does the money come from?

How much money do you get andhow often?


£ every weeks / months / year

/ /

● Statutory Sick Pay● Statutory Maternity Pay● benefits, allowances and pensions not from

social security● student grants or loans● money from a mortgage protection policy● money from a charity or benevolent fund● Working Tax Credit and Child Tax Credit.

No

Yes

No

Yes

No

Yes

13

Part 10: About other money continued

Do you get any payments froma credit insurance policy orpayment protection plan?

What items, if any, were bought usingthe credit that you had?

Which of these items are covered bythe insurance policy?

Who does the insurance companymake the payments to?

How much is paid and how often?

Direct to the supplier To you

When did the payments start?

When will the payments end?

To the credit company

Do you hold any money or property,in this country or abroad, whichbelongs to someone else?By money we mean things like bankaccounts or investments.

Is this money orproperty in your name?

Tell us about them inPart 16 Other information.

Does anyone owe you any money?This might be for things like● arrears of maintenance● money lent to someone.

How much money are you owed?

What is this money owed for?

When do you expect the money tobe paid back?

Do you get In Work Credit?

£

/ /

/ /

/ /

£ every weeks / months

Insurance policy verified? No Yes

Tell us about this below. Then go to Part 13Other people who live with you.

Do you live with parents, relativesor friends as part of their family?

Full name of the head of household

Relationship to you. For example parent, friend or relative.

Part 11: Where you live

No

Yes

No

Yes

No

Yes

No

YesNo

Yes

No

Yes

Part 11: Where you live continued

Name of your local council

Address of your local council

Do you rent your home from a council?If the council is paying for you to stay inbed and breakfast, or a hotel, tick Yes.If you do not pay rent because you getHousing Benefit, tick Yes. To claim Housing Benefit complete form HCTB1 and

send it to your local council. To claim a reduction inCouncil Tax contact your local council direct. HousingBenefit and a reduction in Council Tax do not affect theamount of Jobseeker’s Allowance you get.

Postcode

Do you share the rent or mortgagefor the place where you live withanyone else?

What are the names of the peopleyou share with?

Please tell us the name and address of your local council.

Are you already getting, waiting tohear about or intending to claimHousing Benefit? Housing Benefit and a reduction inCouncil tax do not affect the amount ofJobseeker’s Allowance you get.


Their name

Their address

Do you pay a private landlord orlandlady or housing association forthe place where you live?Tick Yes if you● just pay rent for the place where you

live, or● pay for meals as well, or● live in a hotel, guest house, hostel or

somewhere like this.

Postcode

Please tell us their name and address below.

To claim Housing Benefit complete form HCTB1 andsend it to your local council. To claim a reduction inCouncil Tax contact your local council direct.

14

No

Yes

No

Yes

No

Yes

No

Yes

To claim Housing Benefit complete form HCTB1 andsend it to your local council. To claim a reduction inCouncil Tax contact your local council direct. HousingBenefit and a reduction in Council Tax do not affect theamount of Jobseeker’s Allowance you get.

Is the home where you live acrown tenancy? We will write to you about this.

Do you pay service charges for theplace where you live?For example, cleaning andmaintenance of stairs and hallways.


How much do you pay? £ every

What does this payment cover?For example, cleaning hallways, lightingstairways, general maintenance.

When did you start payingthese charges?

/ /

Are the service charges payable as acondition of your tenancy?

If these charges are shared amongseveral households, tell us what yourshare of the service charge is.

Do any of the service charges includean amount towards a contingencyfund, a reserve fund or a sinking fund? What is the money in this fund to be used for?

If your service charge includes anyamounts for major repairs, please tellus what these repairs are.

Please send us proof of your service charges. For example, anitemised statement from your landlord or a copy of the annual billshowing what items the service charges cover.

Do you agree to Jobcentre Pluscontacting your service provider ormanagement company about yourservice charges, and for your serviceprovider or management companydisclosing information about themto Jobcentre Plus?

Is your landlord a governmentdepartment or the Crown?

We will write to you about this.


15

No

Yes

No

Yes

To claim Housing Benefit complete form HCTB1 andsend it to your local council. To claim a reduction inCouncil Tax contact your local council direct. HousingBenefit and a reduction in Council Tax do not affect theamount of Jobseeker’s Allowance you get.

No

Yes

No

Yes

No

Yes

No

Yes

Do you pay ground rent foryour home?

When the lease was first granted,was it for more than 21 years?

Is your home a leasehold property?

Please send us proof of your ground rent. For example, your lease.

How much is the ground rent? £ every



/ /

Is the ground rent payable as acondition of your occupancy?

Is any part of the place whereyou live rated as a business? Please tell us about this below.

What percentage of the property arebusiness rates paid for?

%

When was the property rated asa business?

/ /

Please send us proof of this. For example, a copy of a Council Tax orrates bill showing the proportion of your home that is business related.

Do you pay any other charges onyour home?For example, rent charges. Please tell us about this below.

How much do you pay? £ every

What does this payment cover?


/ /

If these charges are shared amongseveral households, tell us what yourshare of the charge is.

Do you pay rent under a long termtenancy agreement?By long term tenancy we mean atenancy agreement which is formore than 21 years.

How much is the rent?

£ every

16


No

Yes

No

Yes

No

YesNo

Yes

No

Yes

No

Yes

No

Yes

17

Part 12: Owning your own home

Do you own your own home?Tick Yes if the property isleasehold or freehold.

Go to Part 13 Other people who live with you.

Do you have a mortgage, remortgageor home improvement loan?

Name of lender


Please tell us about the bank, building society orother lender that you pay your loan to.

Loan reference number

£How much did you borrow?

What date was the loan taken out? / /

Whose name is the loan in? Yours

Other

Please tell us their full name and relationship to you.

Is the loan shared with anyone else?This includes someone like anex-partner, parent or other familymember, even if they liveseparately now.

Do they still contribute towardsthe repayments? What percentage of the repayments are you responsible for?

%

Has the loan been taken out topurchase your home?

What date was theproperty purchased? / /

Is this the original loan that wasused to purchase the property?

Please answer the questions below.

£What was the amount originallyborrowed to purchase your home?On what date was theoriginal loan taken out? / /

Who was the original lender?

£How much did you pay back onthe original loan?

Are any of your loans secured onthe property?

To claim a reduction in Council Tax contact your localcouncil direct. Housing Benefit and a reduction inCouncil Tax do not affect the amount of Jobseeker’sAllowance you get.

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

18

Part 12: Owning your own home continued

Do you have an insurance policythat pays the loan if you becomesick or unemployed?

Have you made a claim on theinsurance policy?

You should make a claim as soon as possible.

/ /

When do you expect to get the first payment?

Will the insurance cover yourpayments to the lender?

We will write to you later for more information aboutyour mortgage protection policy.

Is the loan for anything exceptbuying the property? What was the money used for?

Home improvements – we will write to you about this.

Repairs – we will write to you about this.

Other – please tell us what was done with the rest ofthe loan. For example, buying a piece of landor buying a car.

£If the loan was used for transfer ofequity, please tell us how much for.For example, to buy out an ex-partner’sor former owner’s share.

£If the loan was used for debtconsolidation, please tell us howmuch for.Debt consolidation means bringing allyour debts together, so you can startmaking just one monthly payment tojust one lender.

Did this amount include anyredemption fees?A redemption fee is a charge made bythe lender if you pay off the mortgageor home loan early.

Please tell us how much this was for.

£

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

19


Have you purchased your propertythrough a shared ownership schemethrough a Housing Association?

Are you paying part rent andpart mortgage to buy theproperty where you live?

If you have purchased your propertythrough a shared ownershipscheme, do you have to pay aseparate fee to the Home Buy Agentafter 3 years or more?

What was the title of theshared ownership scheme?

Amount of fee.

£

No

Yes

No

Yes

No

Yes

20


Do you have a second loan onyour home?

Name of lender







Other



Do they still contribute towardsthe repayments?





/ /




What percentage of the repayments are youresponsible for? For example, 50%.

%

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

21


What was the money used for? Home improvements – we will write to you about this.


Other – please tell us what was done with the rest of the loan.For example, buying a piece of land or buying a car.




Please tell us how much this was for.

£

Do you have another loan onyour home?

Name of lender







Other

No

Yes

No

Yes

22




Do they still contribute towardsthe repayments?

What percentage of the repayments are youresponsible for? For example, 50%.

%





/ /




What was the money used for?


Home improvements – we will write to you about this.


Other – please tell us what was done with the rest of the loan.For example, buying a piece of land or buying a car.

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

23




Please tell us how much this was for.£

Do you have any othermortgages or loans?


Please use the space below to give us the samedetails as you already have for your first 3 loans.

How many loans do you or your partner havethat you haven’t already told us about?

Do you agree to Jobcentre Pluscontacting your loan provider aboutyour mortgage, remortgage or homeimprovement loan, and for yourlender disclosing information aboutthem to Jobcentre Plus?This is so we can get all theinformation we need to make a quickdecision on your claim.

No

Yes

No

Yes

No

Yes

24

Part 13: Other people who live with you

We need to know about any other people who live in the same household as you.We need this information to make sure we work out your housing costs correctly.

Please tell us about:● children or qualifying young persons you have not

already told us about in Part 11● relatives if they live in your household● boarders and lodgers● friends● anyone else who lives in the same household.

Do not tell us about:● members of your immediate family, if you live with

them in their household● people who just share a hall or bathroom or toilet with

you, or who live in a separate flat or bedsit in the samehouse

● other residents, if you live in a care home● foster children, or children or qualifying young persons

boarded out with you while they wait to be adopted.

Does anyone live in the samehousehold as you who you havenot already told us about?

Go to Part 14 Special circumstances.

Sex Male

Full name


Date of birth / /

Relationship to you

What do they do?For example, full-time student, studentnurse, apprentice, careworker,Work Based Training for Young People,work, at school.If they are a student, tell us the first andlast date of the current academic year.

/ / / /to

Do they pay you rent,or board and lodging? Please tell us how much and how often this is.

£ every

Person 1

Has the person shared accommodationwith you in the past?

Do they normally live with you?

If No, where do they normally live?

What date did you start sharing thisaccommodation with this person?

Why did you start to shareaccommodation with this person?

How long do you expect this to continue?

Why do you think this?

No

Yes Please tell us about these people.

Female

No

Yes

No

Yes

/ /

No

Yes

25

Part 13: Other people who live with you

If you need to tell us about more than 2 people, please tell us about this in Part 16 Other information.

Person 2

Sex Male

Full name


Date of birth / /

Relationship to you

What do they do?For example, full-time student, studentnurse, apprentice, careworker,Work Based Training for Young People,work, at school.If they are a student, tell us the first andlast date of the current academic year.

/ / / /to

Do they pay you rent,or board and lodging? Please tell us how much and how often this is.

£ every

Has the person shared accommodationwith you in the past?

Do they normally live with you?

If No, where do they normally live?

What date did you start sharing thisaccommodation with this person?

Why did you start to shareaccommodation with this person?

How long do you expect this to continue?

Why do you think this?

Female

No

Yes

No

Yes

/ /

No

Yes

26

Part 13: Other people who live with you continued

Tell us about● earnings● social security benefits● any other money they have coming in.If they have earnings, tell us the amount before tax,National Insurance and any other money has beentaken off.

Do not tell us about any money from● Attendance Allowance● Disability Living Allowance● Personal Independence Payment● the Macfarlane Trust ● the Fund● the Eileen Trust● the Independent Living Fund● the Skipton Fund, or● MFET Limited.

We need to know if any of the people living with you have any money coming in.You do not have to answer these questions, but if they do not have much money comingin you may get more Jobseeker’s Allowance.

Do they work for 16 hoursor more a week? What is their gross pay?

£

How often are they paid? For example, weekly or monthly.

Do they get Income Support,Jobseeker’s Allowance,Employment and SupportAllowance or Pension Credit?

Tell us which.

Do they have any othermoney coming in? What is this?

How much is it each week?

£

Person 1

No

Yes

No

Yes

No

Yes

27

Part 13: Other people who live with you continued

Are any of these people you havetold us about ● married to each other or living

together as if they are married, or● civil partners or living together as

if they are civil partners?We call these people partners.

Please tell us about them.

is the partner of

is the partner of

If you need to tell us about more than 2 people, please tell us about this in Part 16 Other information.

Person 2

Do they work for 16 hoursor more a week? What is their gross pay?

£

How often are they paid? For example, weekly or monthly.

Do they get Income Support,Jobseeker’s Allowance,Employment and SupportAllowance or Pension Credit?

Tell us which.

Do they have any othermoney coming in? What is this?

How much is it each week?

£

No

Yes

No

Yes

No

Yes

No

Yes

28

Part 14: Special circumstances

Are you pregnant?When is the baby expected?

Are you registered blind or severelysight impaired?If you were registered blind or severelysight impaired but came off the registerin the last 28 weeks, please tell us aboutthis in Part 16 Other information.

Are you in hospital?When did you go into hospital?

Name and address of hospital?

Please answer all of these questions, even if you think they do not apply to you.

/ /

/ /

Postcode

Is anyone you have told us aboutin Part 13 registered blind orseverely mentally impaired?

Is anyone you have told us aboutin Part 13 in hospital? When did they go into hospital?

/ /

When are they expected to comeout of hospital?

/ /

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

29

Part 14: Special circumstances continued

You must answer all these questions. If you do not, your claim may be delayed.By the United Kingdom (UK) we mean England, Scotland, Wales and Northern Ireland.

If a UK national, do you have the rightof abode in the UK? For example, you have the right of abodein the UK if you are a British citizen.By the right of abode we mean you● are free from immigration control,

and● do not need the permission of an

immigration officer to enter the UK,and

● can live and work in the UK withoutrestriction.

At any time, have you come to live orreturned to live in the UK from abroad?

What is your nationality?

Was this to work in the UK?

What country have you come from?

Please tell us about this below. And please sendpassport or immigration documents with this form.Or you can bring the passport or documents toyour local Jobcentre Plus.

/ /If you have lived in the UK before,when did you last leave the UK?

Has the Home Office put a limit onhow long you can stay in the UK?

Does your passport say no recourseto public funds?

Have you come to the UK under theFamily Reunion Scheme?

eHRT completed? No YesFor our use

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

30

Part 14: Special circumstances continued

Have you come to the UK under asponsorship undertaking?

A sponsorship undertaking is a form that a relative must sign to say that theywill pay for your living expenses if you settle in the UK. You can find out moreby visiting www.ukvisas.gov.ukA sponsorship undertaking is not the same as the Family Reunion Scheme.


If more than one sponsor signed the sponsorship undertaking,please tell us about them in Part 16 Other information.

Home Office reference number

What date did the sponsor sign thesponsorship undertaking?

We may get in touch with you formore information.

Address of the sponsor

Name of the sponsor

Postcode

/ /

Are you an asylum seeker?

Have you recently had a successfuldecision on your asylum application?

Have you been supported by theHome Office while waiting for adecision on your asylum application?

Did you first apply for asylumbefore 3 April 2000?

If you are still an asylum seeker, you will not usually beentitled to benefit. But you may be entitled to get helpfrom the Home Office.Send us proof of the asylum application with this form.Or you can bring the proof to your local Jobcentre Plus.

What was the date when you gotthe successful decision of yourasylum application?

Send us proof of the decision with this form. Or you canbring the proof to your local Jobcentre Plus.

Send us details of any support given to you by the Home Office.For example, a letter from the Home Office which tells us aboutthese things.

/ /

eHRT completed? NoYes

For our use Passport with UK visa / UK residence permit /NASS 35 provided? NoYes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

31

Part 15: How we pay you

We normally pay your money into an account.Many banks and building societies will let you collect your money at the post office.We will tell you when we will make the first payment and how much it will be for. We will tell you if theamount we pay into the account is going to change.Finding out how much we have paid into the accountYou can check your payments on account statements. The statements may show your National Insurance(NI) number next to any payments we have made. If you think a payment is wrong, get in touch with theoffice that pays you straight away.If we pay you too much moneyWe have the right to take back any money we pay that you are not entitled to. This may be because of theway the payment system works. For example, you may give us some information, which means you are entitled to less money.Sometimes we may not be able to change the amount we have already paid you. This means we will havepaid you money that you are not entitled to.We will contact you before we take back any money.

What to do now● Tell us about the account you want to use on the next page. By giving us your account details you:

– agree that we will pay you into an account, and – understand what we have told you above in the section If we pay you too much money.

● If you are going to open an account, please tell us your account details as soon as you get them.● If you do not have an account, please contact us and we will give you more information.Fill in the rest of this form. You do not have to wait until you have opened an account or contacted us.

32

Part 15: How we pay you continued

Name of the account holderPlease write the name of the accountholder exactly as it is shown on thechequebook or statement.

Sort codePlease tell us all 6 numbers,for example: 12-34-56.

Account numberMost account numbers are 8 numberslong. If your account number hasfewer than 10 numbers, please fill inthe numbers from the left.

Full name of bank or building society

Building society roll orreference numberIf you are using a building societyaccount you may need to tell us a roll orreference number. This may be made upof letters and numbers, and may be up to18 characters long. If you are not sure ifthe account has a roll or referencenumber, ask the building society.

You may get other benefits andentitlements we do not pay into anaccount. If you want us to pay them intothe account above, please tick this box.

About the account you want to use● You can use an account in your name, or a

joint account.● You can use someone else’s account if:

– the terms and conditions of their account allow this,and

– they agree to let you use their account, and– you are sure they will use your money in the way you

tell them.● You can use a credit union account. You must tell us the

credit union’s account details. Your credit union will beable to help you with this.

● If you are an appointee or a legal representative actingon behalf of the claimant, the account should be in yourname only.

Please tell us your account details below. It is very important you fill in all the boxes correctly,including the building society roll or reference number,if you have one. If you tell us the wrong account detailsyour payment may be delayed or you may lose money. You can find the account details on your chequebook orbank statements. If you do not know the account details,ask the bank or building society.

Part 16: Other information

Please use this space to tell us anything else you thinkwe might need to know.Continue on a separate sheet of paper, if necessary.Make sure you tell us who the information is about.

Sign and date the sheet of paper and write your full name,National Insurance number and address on it.

33

Signature Date

34

Part 17: Declaration

/ /

Please read the notes at the front of this form before you sign and date it.

Please tick this box if someone filled inthis form for you.

I understand that● if I knowingly give information that is incorrect or incomplete, my benefit may be stopped and

I may be liable to prosecution or other action● I must promptly tell the office that pays my benefit of anything that may affect my entitlement to,

or the amount of, that benefit● the information I have provided will be used to process my claim for Jobseeker’s Allowance and

may be used to decide my entitlement to other benefits. Some of the information may be checkedwith other sources

● any information provided in connection with this and any other claim may be used in connectionwith this and any other claim to social security benefits (including Housing Benefit) that I havemade or may make

● the information may be used for other purposes relating to the work of the Department for Workand Pensions. Some information may be given to other government bodies as permitted by law.

I declare that● the information I have given on this form is correct and complete as far as I know and believe and

I have included all my income and savings. Under sections 111A(1A) and 112(1A) of the Social Security Administration Act 1992 it is an offence tofail to notify a change of circumstances promptly. Failure to tell us about a change in yourcircumstances promptly may result in action being taken against you.

This is my claim for Jobseeker’s Allowance.

Part 18: About your interview

35

Time

Day

Place

am / pm

Name

/ /

Our phone number

Date

Your interview is at

Your interviewThe purpose of your interview with the adviser is to● make sure you are available for and actively

seeking work● talk about types of work you are looking for and the

best way of finding it● talk about jobs, training and the other

opportunities available● draw up a Jobseeker’s Agreement● make sure your claim form is fully completed.Please bring the claim forms and any papers we need toyour interview.Please be on time. If you are late or your forms areincomplete we may not be able to interview you. You mayhave to make another appointment which will delay thedecision on your claim. If you cannot come to your interview for any reason,please let us know as soon as possible. We will makeanother appointment as soon as we can.

Your Jobseeker’s AgreementTo get Jobseeker’s Allowance you must have aJobseeker’s Agreement. This sets out details of● when you can work● the types of work you are willing and able to do● what you are going to do to find work and to increase

your chances of finding work – or work and training ifyou are 16 or 17 years old

● the help we will offer.We will discuss your Jobseeker’s Agreement atyour interview.

36

Part 19: What to bring to your interview

Part 20: Our service standards

When you come to your interview please bring● all documents and papers we have asked for, and● proof of your identity. If you cannot bring everything, still claim and come for your interview. If you do not you may lose benefit. We may be able to pay benefit you are entitled to more quickly if you● answer all the questions on this form that apply to you● bring us all the documents we ask for.If you have a CV, please bring it to the interview.

At Jobcentre Plus we aim to provide a high standard of customer service at all times. Details of the standardof service you can expect from us can be found at www.dwp.gov.uk/about-dwpYou can access our website from many libraries.For more information please contact Jobcentre Plus.

The information we collect about you and how we use it depends mainly on the reason for your businesswith us. But we may use it for any of the Department’s purposes, which include ● social security benefits and allowances● employment and training● private pensions policy, and ● retirement planning. We may get information from others to check the information you give to us and to improve our services.We may give information to other organisations as the law allows, for example to protect against crime.To find out more about how we use information, visit our website www.dwp.gov.uk/privacy-policy orcontact any of our offices.

Part 21: How we collect and use information

For our use

DeclarationThe answers I have given to the questions on this formhave been read back to me.

I agree they are correct and complete as far as I knowand believe.

Claimant’s signature

/ /

Interviewing officer’s signature

Date Interviewing officer’s name

Printed on recycled paperJSA1S_102013_014_001

Straightforward

Benefit details

Nam

e

Signature

//

Date

Sanction or LM dec / suspension

ES48 / ESL48 issued

TaxationP45 attached

To bring P45 ON

A

P187 attachedP45 lost / destroyed / not issued

BWE day

Date received/

/

Claim details

//

NIN

O

Claimant’s surnam

e

Outstanding periods of evidence

Effective (TAM) date

Other nam

es

JA060 input

Negative LM dec / susp applies 1

from/

/to

//

Reason for LM dec / susp

Negative LM dec / susp applies 2

from/

/to

//

Reason for LM dec / susp

LM decision / suspension

Cycle

Claim file

Postal signer

//

Jobcentre codeBenefit Processing O

fficeDate of issue

Identity –Claim

antIdentitychecked?

YesNo

Notes

Day of attendanceM

onTue

Wed

ThuFri

For our use

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