Special Benefit Review form (BC048m)

Use this form to confirm your details if you are receiving a special benefit so we can check that you are receiving the right amount.

Download and complete the Special Benefit Review form.

Please fill in your name, address, Customer Reference Number (CRN), the date of issue and the return date on the first page of the form. If you do not know the return date, please contact us so that you can return the review by the due date.

This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.

If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please use self service, request someone to deal with us on your behalf, or contact us. We can help you access, complete and submit them.

Page last updated: 1 July 2020