Welsh Government Winter Fuel Support Scheme 2022 to 2023

Benefit Claim Reference (if you currently Claim Council Tax Reduction)

Contact Phone Number *

Indicate which qualifying benefit you are in receipt of *

Universal Credit

Working Tax Credit

Income Based Job Seekers Allowance

Income Support

Income Based Employment & Support

Council Tax Reduction Scheme (CTRS)

Child Tax Credits

Pension Credit

Personal Independence Payment (PIP)

Disability Living Allowance (DLA)

Attendance Allowance

Carers Allowance

Contributory Based/New Style Jobseekers Allowance

Contributory Based/New Style Employment and Support Allowance

Armed Forces Independence Payment

Constant Attendance Allowance

War Pension Mobility Supplement

None of the above

If you or your partner who are liable for the fuel costs DO NOT receive any of the qualifying benefits, the householder should be considered as eligible for a payment if you have a qualifying person living with you. A person meets the definition of a qualifying person if they :

• Occupy the householder’s home as their primary residence and *

Yes

• Are a dependent child or adult dependant of the householder (or their partner) and *

Yes

• They receive one of the following benefits: *

Attendance Allowance

Disability Living Allowance (DLA)

Personal Independence Payment (PIP)

Armed Forces Independence Payment

Constant Attendance Allowance

War Pension Mobility Supplement

None of the above

Do you have a qualifying person living with you? *

Yes

Are you responsible for paying a Gas or Electricity Bill in your property, for example using a pre-payment meter, via direct debit or by paying your bill quarterly, on or off-grid ? *

Yes

Name on Bank Account *

Bank Sort Code (e.g. 11-22-33) *

Bank Account Number *

I can confirm that the details completed are true and correct. *

Welsh Government Winter Fuel Support Scheme 2022 to 2023

This scheme starts on 26 September 2022.

This scheme starts on 26 September 2022.