The information I have given is correct to the best of my knowledge and I understand that if I provide any information which is false, you may refuse to consider my claim.
If my circumstances change and it may affect my claim, I will tell you straight away.
I give permission for the Authority who gives me benefit or tax credit to give you any information to confirm the information I have provided.
Warning - If you deliberately give us misleading information you are committing a criminal offence and could be prosecuted.
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