Assurance of Support form (MOD AR)

Use this form when the person you provided an assurance of support for has applied for an Assurance of Support Scheme recoverable income support payment.

Download and complete the Assurance of Support form.

To fill in this form digitally you will need a computer and Adobe Acrobat Reader, or a similar program. You can download Adobe Acrobat Reader for free. If you can’t complete the form digitally, you can print it, complete it by hand and return it to us following the instructions on the form.

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: 22 September 2023.
QC 65337