Skip to main content

alpha This is a new site, your feedback will help us to improve it.

Accurate and honest declarations

Published on 22 January 2020

Appendix 1 - Personal Independence Payment

Step 1 Read the statement of consent and sign the Declaration

Giving us your consent to obtain further information

We're looking again at your PIP award. We may want to contact your GP, other people or organisations for information about your health condition or disability and how it affects you.

You don't have to agree to us contacting these people or organisations but if you don't, we may not have all the information we need when we make a decision about your PIP.

Do you agree that:

  • we, or someone working on our behalf, may ask your GP, or other people or organisations, for this information and
  • your GP, or other people or organisations, can give us, or someone working on our behalf, this information?

Yes

No

You can withdraw your conesnt at any time by calling us on 0345 850 3322 or 0300 123 9221


Declaration

I agree that the information I give on this form is complete and correct I understand if I give wrong or incomplete information, my benefit may be stopped and I may be prosecuted or ay have to pay an penalty I understand I ust promptly tel the office that pays my Personal Independence Payment of anything that may affect my entitlement to or the amount of, that benefit.

Signature

Date

Print your name here