About you continued
Signing the form for someone else
• you’ve already been legally appointed to receive and deal with their benefits.
That is, you’re a benefit appointee, a deputy or hold a Power of Attorney, or
• the person you’re claiming for is too ill or disabled to claim for themselves and
you want to be appointed to receive and deal with their benefits, or
• you’re completing this form in their absence and/or without their knowledge.
You can ﬁll in the form for someone else, but they must still sign themselves unless:
Are you signing the form for someone else?
Continue below. Go to question 14.Yes No
Why are you signing the form for them? Please select one of the following.
I’m claiming for them under the special rules for terminally ill people.
You may wish to tell the person y
ou have claimed for that you have made
a claim to this benefit on their behalf. This is because we will send letters
about Attendance Allowance to them. There is no mention of terminal
illness or the special rules in our notifications.
The special rules are for people who have a progressive disease and are not expected
to live longer than another 6 months.
If you are claiming under the special rules you do not need to answer
Then please send this form to us with a DS1500 report. You can get the report
from your doctor or specialist.
If you have not got your DS1500 report by the time you have filled in the claim
form, send the claim form straight away. If you wait, you could lose money.
Please send the DS1500 report when you can.
Please make sure you sign the consent question 18 and the declaration
If you are claiming under the special rules, tick this box.
You must read page 8 of the notes about special rules before you
complete this question.