GOV.

UK Child Benefit: Claimant Customer Copy

change of circumstances

Your submission details

RC
HM
Your reference number is 6G4-TA6B-IFR
Your submission was sent on 8:05pm, Friday 30 April 2021

TO
Submission mark is uS4pwsDK0k9Z3rdaV8q/VOwIYlU=

Summary

RM
Check the information you have given is correct before sending this form.

FO
Type of change

IS
TH
What type of change do you want You've changed your UK address
to tell us about?
IL
MA

Your details
E-

National Insurance number SG561218C

OR

First name SYED

ST

Last name HAIDER

PO

Date of birth 26/09/1982

T

Is your address in the UK? Yes

NO

UK address 42 Gladys Street, Bolton, BL3 2QB

DO

Do you have a contact telephone Yes

number?
SE

Telephone number 07400900157

EA

Your address
PL

Date you changed your address 21/04/2021

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UK address 42 Gladys Street, Bolton, BL3 2QB

Have you moved to or from No

Northern Ireland?

RC
Have all the children you claim No

HM
child benefit for moved with you to
your new address

TO
Child 1

RM
Child's full name Liyana Syed

FO
Child's date of birth 08/08/2016

IS
Child 2

Child's full name TH

Anna Syed
IL
Child's date of birth 24/03/2018
MA
E-
OR
ST
PO
T
NO
DO
SE
EA
PL

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