Form

Employment and Support Allowance claim form

Use this form to claim Employment and Support Allowance (ESA) if you're eligible. You may be able to apply for Universal Credit.

Documents

Details

You may not have to fill in this form. The quickest way to apply for ESA is by phone.

You may be able to apply for Universal Credit. Check you’re eligible for ESA before you apply.

Where to send your form

Send the completed form to your Jobcentre Plus office.

Published 1 April 2013
Last updated 31 July 2017 + show all updates
  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.