Form

Personal Independence Payment: sample claim form

Sample claim form for support organisations that work with people who may be entitled to Personal Independence Payment.

Documents

Sample Personal Independence Payment claim form (for reference only)

This file may not be suitable for users of assistive technology. Request an accessible format.

If you use assistive technology (eg a screen reader) and need a version of this document in a more accessible format, please email accessible.formats@dwp.gsi.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

Personal Independence Payment: additional information

Welsh: Taliad Annibyniaeth Personol ffurflen gais

This file may not be suitable for users of assistive technology. Request an accessible format.

If you use assistive technology (eg a screen reader) and need a version of this document in a more accessible format, please email accessible.formats@dwp.gsi.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

Detail

This sample Personal Independence Payment (PIP) form is for support organisations that work with people who may be entitled to PIP. It is for reference purposes only, to demonstrate the clerical form that we send to people who cannot use the phone to claim PIP.