Form

Employment and Support Allowance claim form

Employment and Support Allowance (ESA) claim form.

Documents

Details

Where to send your form

Send the completed form to your Jobcentre Plus office.

Other ways to claim

You may not have to fill in a form. There are other ways to claim.

Published 1 April 2013
Last updated 31 July 2017 + full page history
  1. Revised notes for ESA1 interactive form. New contact details for online helpdesk.
  2. Published revised ESA claim form you can print and fill in with a pen – English and Welsh.
  3. Published revised ESA claim form you can download, fill in on screen, save – and then print.
  4. Expanded notes section to inlcude advice for claimants who have claimed ESA before.
  5. Added updated versions - Oct 2013.
  6. First published.