Template Example Of Completed Pip Form UK

The Completed PIP Form Example UK is provided in multiple formats, including PDF, Word, and Google Docs, offering customizable and printable versions for your convenience.

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Template Example Of Completed Pip Form UK

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PDF – 1 PDF – 2

Template Example of Completed PIP Form UK

1. Personal Information



2. Contact Information

3. Disability Information

4. Daily Living Activities

5. Mobility Activities

6. Additional Support Needs

7. Medical Evidence

8. Declaration

9. Authorisation

10. Signatures


PDF

WORD

Examples

Template Example Of Completed PIP Form UK (1)
Personal Information:
[Name of the Applicant]
[Applicant’s National Insurance Number]
[Applicant’s Address]
[Applicant’s Phone Number]
[Applicant’s Email]
Claim Reference:
[Claim Number issued by the DWP]
Mobility Needs:
Please describe your mobility difficulties, including how far you can walk before experiencing discomfort or pain.
Daily Living Needs:
Detail any challenges you face with everyday tasks such as cooking, cleaning, or personal hygiene.
Additional Information:
Include any medical conditions, disabilities, or support needs that impact your ability to carry out daily living and mobility activities.
Support Documentation:
Attach any relevant medical reports, assessments, or supporting letters from health care professionals.
Declaration:
I declare that the information provided is true and complete. I understand that providing false information could lead to prosecution or withdrawal of benefits.
[Signature of the Applicant]
[Date Signed]
Template Example Of Completed PIP Form UK (2)
Applicant Details:
[Name of the Applicant]
[Applicant’s National Insurance Number]
[Applicant’s Address]
[Applicant’s Phone Number]
[Applicant’s Email]
PIP Reference Number:
[Personal Independence Payment Reference Number]
Medical Condition:
Please specify your disabilities or medical conditions and how they affect your daily life.
How It Affects Daily Life:
Explain the impact of your condition on your ability to manage daily tasks and engage in social activities.
Mobility Challenges:
Describe your difficulties with movement, including any assistive devices you use (e.g., wheelchair, walking aids).
Care Needs:
List the support you require from others in your daily activities and any changes to your care needs over time.
Supporting Evidence:
Please include copies of any supporting evidence such as medical reports or letters from health professionals.
Applicant’s Declaration:
I confirm that all information provided is accurate and complete to the best of my knowledge.
[Signature of the Applicant]
[Date Signed]

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PDF – 1 PDF – 2

Template Example Of Completed Pip Form UK