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. 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 January 2021