Claim Child Benefit for one or

more children (CH2)

Applicant details
National Insurance number
ST024418C
Last name
DUDUVEICA
First name
ROMEO
Middle names
GRAFIAN
Date of birth
15 January 1995
Current address
FLAT 17 FRIARY CLOSE
5 HAMSTED HALL ROAD
BIRMINGHAM
ENGLAND
B201HP
Nationality
Romania
Always lived in the UK
Yes
HMF or civil servant abroad
No
Marital or civil partnership status
Living with a partner
Living with partner since
21 April 2019
Benefits received
Universal Credit
Telephone number
07474659965
Currently claiming Child Benefit
No

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 Claim Child Benefit for one or
more children (CH2)

Partner details
Partner National Insurance number
TL515013B
Last name
Pruteanu
Full name
Semat Pruteanu
Date of birth
13 December 2000
Nationality
Romania
Currently claiming Child Benefit
No

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 Claim Child Benefit for one or more
children (CH2)

Child 1 details
Last name
Duduveica
First name
Rares
Middle names
Boyka
Sex as recorded on child’s birth certificate
Male
Date of birth
29 February 2020
Country of birth registration
Other country
Birth certificate number
Not provided
Child is living with applicant
Yes
Applicant’s relation to child
Birth child
Applicant adopting child via Local Authority
No
Child Benefit claimed for this child
No
Known by any other names
No
Documents being sent for child
Birth certificate
Passport or travel documents

For official use only

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 Claim Child Benefit for one or
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Payment details
Wants to be paid Child Benefit
Yes
Child Benefit payment frequency
Weekly
Paid into existing bank account
No
Sort code
778566
Account number
00953889
Account holder
Applicant
Name of bank or building society
Tsb
Name on account
Romeo Grafian Duduveica

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 Claim Child Benefit for one or
more children (CH2)
Additional information
I have made a claim for child benefit for my child in 2021 but it not get paid so I’m claiming
again to se how it works I request to be paid back

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 Claim Child Benefit for one or more
children (CH2)

Declaration
I am sending the birth certificate(s) or other documents that you need with this form.
X I understand if I do not send the documents that you need with this claim form, a
decision on my claim will be delayed. I am not sending photocopies.

I declare that the information I’ve given on this form is correct and complete. If I give
X information which I know is not correct or complete, you may take action against me.
I’ll tell you about changes to my circumstances when they happen and understand I
could be overpaid and may have to pay money back if I do not.

Signature

Date
Day Month Year

D D / M M / Y Y Y Y

For official use only

Corres Traced CLI Date claim received

Corres Traced CLI

Document(s) returned
Birth certificate Normal
Passport Recorded
Other Registered

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 Claim Child Benefit for one or more
children (CH2)

What to do now
After you have printed this form and signed and dated the Declaration, return the form with
any documents we need to:

Child Benefit Office (GB)

Washington
NEWCASTLE UPON TYNE
NE88 1ZD

You’ll need a stamp for the envelope; make sure you pay the correct postage.

An extra sheet with your name and address will be printed with your claim form if you are
sending us any documents. Make sure that this is sent to us with your claim. We use it to
send any documents back to you.

You’ll need a stamp on the outside of your envelope to post your form and documents to us,
don’t send the stamp to us separately. Make sure you pay the correct postage.

What happens next

We’ll review your claim and write to tell you if you can get Child Benefit and how much you’ll
get. We’ll normally return any documents you have sent us within 4 weeks.

If you need further assistance with your claim, contact the Child Benefit helpline.

Telephone: 0300 200 3100

Outside UK: +44 161 210 3086

You can also use Relay UK if you cannot hear or speak on the phone: dial 18001 then 0300
200 3100.
 Address label - send this back with
your completed form

ROMEO GRAFIAN DUDUVEICA

FLAT 17 FRIARY CLOSE
5 HAMSTED HALL ROAD
BIRMINGHAM
ENGLAND
B201HP

Send this address label back to us with your completed claim form so that we can return your
documents to you.

You’ll need a stamp on the outside of your envelope to post your form and documents to us,
don’t send the stamp to us separately. Make sure you pay the correct postage.

Important - if you do not send this address label with your claim form, it may take us
longer to send your documents back to you and to make a decision on your claim.

HMRC use only - we’ll use this when we send your documents back to you.

Your documents
Thank you for sending us your claim form, I have enclosed your:

X Birth certificate(s) X Passport(s)

X Travel document(s) X Adoption certificate(s)

X Other document(s)

You do not need to do anything - we’ll write to you again as soon as we’ve made a
decision about your claim.