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Please complete the following.
Title
Firstname
Surname
Address 1
Address 2
Address 3
City
County
Postcode
E-mail
Tel No
Over70
Income Support
Housing Benefit
Council Tax Benefit(not including single occupancy reduction)
Income based Jobseeker's Allowance
Attendance Allowance
Disability Allowance
Industrial Injuries Disablement Pension Benefit
(must include mobility suppliment or Constant Attendance Allowance)
Pension Credit
Child Tax Credit(where your income is £14,600 or less)
Working Tax Credit(where your income is £14,600 or less)
*Calls provided by BT will be charged at up to 3 pence per minute. A setup fee of 3p per call applies to all residential calls. Mobiles and other providers may vary.
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