Form

Approved third party professionals who can complete these forms

Updated 8 November 2023

The following people can complete parts 2 and 3 of the form to claim extra benefit or tax credits for a third or subsequent child conceived without your consent.

UK wide

Any of the following:

  • a healthcare professional in a Sexual Assault Referral Centre
  • other healthcare professionals, such as a doctor, midwife, nurse or health visitor
  • a registered social worker
  • a specialist support worker from one of the following approved organisations

Northern Ireland

A specialist support worker from one of the following organisations in Northern Ireland.

Organisation Location
Belfast and Lisburn Women’s Aid Belfast and Lisburn
Foyle Women’s Aid Foyle

Wales

A specialist support worker from Rape Crisis England and Wales.

England

A specialist support worker from Rape Crisis England and Wales.

A specialist support worker from one of the following organisations in England.

Find contact details for these organisations in England.

Organisation Location
HARV Outreach Team Accrington
Andover Crisis and Support Centre Andover
Centra Kent - DV services Ashford
Aylesbury Women’s Aid Aylesbury
Deaf Hope (UK) Balham
Pathways Centre (BDVG) Barnsley
North Devon Against Domestic Abuse Barnstaple
Changing Pathways Basildon
Renew Bath
Butterfly House Bedford
Stonewater Asian Women’s Refuge (SAWR) Bedford
Bexley Women’s Aid Bexley Heath
Wirral Women and Children’s Aid Birkenhead
Birmingham & Solihull Women’s Aid Birmingham
Gilgal Birmingham
Roshni - Birmingham Birmingham
Wear Valley Women’s Aid Bishop Auckland
Blackburn Darwen & District Without Abuse Blackburn
Humraaz Blackburn
Fylde Coast Women’s Aid Blackpool
Women’s Rape & Sexual Abuse Centre (Cornwall) Bodmin
Fortalice Ltd Bolton
Paws for Kids - Endeavour Project Bolton
Boston Women’s Aid Boston
Anah Project Bradford
Bradford Women’s Aid Bradford
Palm Cove Society - Domestic Violence Services Bradford
Staying Put Bradford
The Acorns Calderdale Domestic Abuse Service (Stonham) Brighouse
RISE (Refuge, Information, Support and Education) Brighton
Next Link Domestic Abuse Services Bristol
Survive South Gloucestershire & Bristol Bristol
Safenet Domestic Abuse Service Burnley
Bury St Edmunds Women’s Aid Centre Limited Bury St Edmunds
Cambridge Women’s Aid Cambridge
Rising Sun Domestic Violence & Abuse Service Canterbury
Derbyshire Domestic Violence and Sexual Abuse Service Chesterfield
North Wiltshire Woman’s Refuge Chippenham
Colchester and Tendring Women’s Refuge Colchester
Coventry Haven Ltd Coventry
Harbour Support Services Co Durham
Cheshire Without Abuse Crewe
Darlington Family Help Darlington
Harbour Support Services Darlington
Choices Dartford
Kennet House Refuge Devizes
Churches Housing Association of Dudley and District Ltd (CHADD) Dudley
Family Aid Fareham
Stonham - Gateshead Women’s Service and Refuge Gateshead
Crossroads Derbyshire Glossop
Gloucestershire Domestic Abuse Support Services Gloucester
North East Lincolnshire Women’s Aid Grimsby
Chapter 1 - South West Surrey Domestic Abuse Services Guildford
Arch North Staffordshire - Domestic Abuse Services Hanley
Harbour Support Services Hartlepool
Southern Domestic Abuse Service Havant
Dacorum Women’s Refuge Hemel Hempstead
Wycombe Women’s Aid High Wycombe
Pennine Domestic Violence Group Huddersfield
Hull Women’s Aid Hull
Lighthouse Women’s Aid Ipswich
Springfield Kendal
Liverpool Domestic Abuse Service (LDAS) Kensington
Angel House (Lancashire Pendle
Behind Closed Doors Leeds
Leeds Women’s Aid Leeds
Action Homeless (Leics) Ltd - Bridge House Leicester
Free VA Leicester
Women’s Aid Leicestershire Ltd Leicester
Clare House - South Ribble Women’s Refuge Leyland
Burntwood Pathway Project Lichfield
Amadudu Liverpool
Betterdays Homes for Domestic Violence Liverpool
South Liverpool Domestic Abuse Services Liverpool
The First Step Liverpool
ADVANCE Advocacy Project London
Al-Hasaniya, Moroccan Women’s Centre London
Asha Projects London
Ashiana Network London
Bede House Association - Starfish Project London
Bromley and Croydon Women’s Aid London
Enfield Muslim Women’s Aid London
Hestia Housing and Support Domestic violence services London
Hounslow Domestic and Sexual Violence Outreach Service London
Housing for Women DV Services London
Imkaan London
Iranian and Kurdish Women’s Rights Organisation (IKWRO) London
Jewish Women’s Aid London
Latin American Women’s Aid London
London Black Women’s Project London
Lookahead Care & Support - Domestic Abuse Services London
Solace Women’s Aid London
The NIA Project London
Watford Women’s Refuge London
Woman’s Trust Counselling and Support Services London
Living Without Abuse Loughborough
Women’s Aid in Luton Luton
Independent Choices Domestic Abuse Helpline Manchester
Manchester Women’s Aid Manchester
Saheli Ltd Manchester
Trafford Domestic Abuse Services Manchester
Nottinghamshire Independent Domestic Abuse Services (NIDAS) Mansfield
Oasis Domestic Abuse Service Margate
Halo Project Middlesbrough
My Sister’s Place Women’s Advice Centre Middlesbrough
Harbour Support Services Middlesbrough
MK ACT Milton Keynes
Positive Action in the Community Nelson
Newcastle Women’s Aid Newcastle
Angelou Centre Newcastle Upon Tyne
Northampton Women’s Aid Northampton
West Cheshire Domestic abuse Family Safety Unit Northwich
Harbour Support Services North Tyneside
Leeway Domestic Violence & Abuse Services Norwich
Broxtowe Women’s Project Ltd Nottingham
Midlands Women’s Aid Nottingham
Newark Women’s Aid Nottingham
Nottingham Central Women’s Aid Nottingham
Women’s Aid Integrated Services Nottingham
A2 Dominion (Oxfordshire Domestic Abuse Services) Oxfordshire
Peterborough Women’s Aid Peterborough
Preston Domestic Violence Services Preston
The Star Centre Rawtenstall
Berkshire Women’s Aid Reading
EVA Women’s Aid Redcar
East Surrey Domestic Abuse Services Redhill
Reigate & Banstead Women’s Aid Reigate
North Denbighshire Domestic Abuse Service Rhyl
Havering Women’s Aid Romford
Action Domestic Abuse Service Rotherham
Families First Rugby
Wight DASH Ryde
Salisbury Women’s Refuge Salisbury
North Lincolnshire Women’s Aid Scunthorpe
Sheffield Area Refuge and Support Sheffield
South Shropshire Domestic Violence Service Shropshire
The Liberty Centre Skelmersdale
The Dash Charity Slough
Southampton Women’s Aid Southampton
St Albans & Hertsmere Women’s Refuge St Albans
Staffordshire Women’s Aid Stafford
Stockport Without Abuse Stockport
Harbour Support Services Stockton on Tees
Aegis Counselling Service Stokesley
Beresford Group, Stroud Stroud
Swindon Women’s Aid Swindon
Salford Women’s Aid Swinton
Sutton Women’s Aid Wallington
Aven House Women’s Refuge Walsall
North Surrey Domestic Abuse Outreach Walton On Thames
Warrington Women’s Aid Warrington
Wearside Women in Need Washington
Afganistan Capacity Development and Educational Organisation Watford
Wellingborough & East Northamptonshire Women’s Aid Wellingborough
Welwyn Hatfield Women’s Refuge & Support Services Welwyn Garden City
Black Country Women’s Aid West Bromwich
West Mercia Women’s Aid  
SOS Domestic Abuse Projects Westcliff On Sea
your Sanctuary Woking
The Haven Wolverhampton Wolverhampton
Stonham - Worcestershire Domestic Abuse Services Worcester
Nottinghamshire Women’s Aid Worksop
Safe in Sussex Worthing
Independent Domestic Abuse Services York