Free School Meal Application Form

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Please complete this form if you believe you may be entitled to benefit related free school meals. You must complete one form per child.

Is your joint family income over £16,190 per year?

Yes

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If you have ticked yes, you do not need to complete this section. If you ticked no, please indicate if you are in receipt of any of the benefits listed below:

Income Support

Income-based Jobseekers Allowance

Income-related Employment and Support Allowance

Universal Credit - If you apply on or after 1 April 2018 your household income must be less than £7,400 a year (after tax and not including any benefits you get)

Support under Part V1 of the Immigration and Asylum Act 1999

The guarantee element of Pension Credit

Child Tax Credit (provided you're not also entitled to working Tax Credit and have an annual gross income of no more than £16,190.

Working Tax Credit run -on - paid for 4 weeks after you stop qualifying for Working Tax Credit.

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First Parent/Carer full name

First Parent/Carer Date of Birth

YYYY

Frist Parent/Carer National Insurance Number

Second Parent/Carer full name (if applicable)

Second Parent/Carer Date of Birth

YYYY

Second Parent/Carer National Insurance Number

Full Name of Child *

Date of Birth of child that attends Buckingham Primary School.

YYYY

The information I have given on this form is complete and accurate. I understand that my personal information is held securely and will be used only for local authority purposes. I agree to the local authority using this information to enable my child's school to claim pupil premium.

Name of Parent/Carer completing this form

Date

YYYY

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