Claim for Special Benefit form (SU004)

Use this form to claim Special Benefit if you are in severe financial hardship due to circumstances beyond your control.

Download and complete the Claim for Special Benefit form.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.

Page last updated: 31 March 2020