Do you receive any of the following benefits?

• Income Support.
• Income based Jobseeker's Allowance.
• Income related Employment Support Allowance.
• Support under Part VI of the Immigration and Asylum Act 1999.
• The guaranteed element of State Pension Credit.
• Child Tax Credit - as long as you have a yearly household income of less than £16,190 (as assessed by HM Revenue and Customs) and do not get Working Tax Credit.
• Working Tax Credit run-on (paid for 4 weeks after you stop qualifying for Working Tax Credit).
• Universal Credit - provided you have an annual net earned income not exceeding £7,400 (£616.67 per month).

If you are getting one of the benefits listed above, please click Next and continue with your application.

Liverpool City Council is committed to making sure that our services are accessible to all members of the community. You do not have to answer the following questions about yourself, but if you do, it will help us to improve access to our services. This information is confidential and we will only use it to improve our services.

I understand that my entitlement to free School Meals will continue only for as long as I receive one of the benefits listed above and I agree to inform you immediately if my benefit or tax credit entitlement changes, if I change my address or if my child(ren) change school.

I confirm that the information on this form is to the best of my knowledge and belief correct and complete, and I give permission for Liverpool City Council to check my eligibility status with the Department for Work and Pensions and HM Revenue and Customs.

I agree that you will use the information I have provided to process my claim for free school meals.

I agree that you can inform the school(s) attended by my child(ren) of their entitlement to free school meals

You may use the information I have given to you in connection with this and any other claim for social security benefits that I have made or may make. You may give some information to other government organisations, if the law allows this.

Data protection

Please tick this box if you do not want us to use the information on this form to tell you about your possible entitlement to other benefits, discounts grants and council services.

Liverpool City Council is under a duty to protect the public funds it administers, and to this end may use the information you have provided on this form for the prevention and detection of fraud.

It may also share this information with other bodies responsible for auditing or administering public funds for these purposes.

If you have any questions about this form please call 0151 233 3009 or Freephone 0800 0283697, or email benefits.service@liverpool.gov.uk