Form

New style Employment and Support Allowance (ESA) claim form

You may be able to claim new style ESA with, or instead of, Universal Credit, depending on your National Insurance record.

Documents

Details

Check you’re eligible for new style ESA before you apply.

You’ll need to book a new claim appointment at your jobcentre, if you have not already arranged one. Take this form to the appointment.

Book a new claim appointment

Telephone: 0800 328 5644
Textphone: 0800 328 1344
NGT text relay (if you cannot hear or speak on the phone): 0800 328 5644
Monday to Friday, 8am to 6pm
Find out about call charges

Call this number if you need this form in Braille, large print or audio.

You can also visit your local jobcentre to get a form and book an appointment.

Published 6 March 2019
Last updated 30 April 2019 + show all updates
  1. Removed options to choose when phoning to book a new claim appointment as these are no longer correct.
  2. Added welsh version of the form.
  3. First published.