Department for Work and Pensions

This publication is withdrawn. This publication is no longer current.
Schedule 2 Appendix 1

Provider:		CPA:		Invoice Ref:		
Date of claim:		Completed by:				

PRaP Reference No	Exemption from (please state the MPL or CSS)	Reception interview date initially offered	Booked Reception interview date 	Start date for GW course offered	Booked Start date for GW course 	Date (s) of course (s) cancelled if applicable	Course location	Reason for exemption request	Exemption accepted or rejected (to be completed by the DWP PM)	Notes (include supporting evidence from DWP)	

											

				
Signed by (to be completed by DWP PM):		Date: