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Form 3

Parent or carer details

Date of birth
For example, 31 03 1980
Have you moved in the last 12 months

Enter previous address

If you are unable to give us your National Insurance number attach proof of benefit

Documents accepted with your application:

For Child Tax Credit a full copy of your current TC602 Tax Credit award notice

For the following benefits a letter of entitlement dated within the last 6 weeks

  • Employment and support allowance (income based)
  • Income support
  • Job seekers allowance (income based)
  • The Guarantee element of state pension credit
  • Support under part VI of the immigration and Asylum Act 1999

All pages of the document must be provided

Previous
<h1 class="heading-large">Parent or carer details</h1>

<form action="form_4" method="post">
<div class="content-block">

    <div class="form-group">
        <label for="first-name">
            <span class="form-label-bold">First name</span>
        </label>
        <input class="form-control" id="first-name" type="text" name="parent-carer-first-name">
    </div>

    <div class="form-group">
        <label for="last-name">
            <span class="form-label-bold">Last name</span>
        </label>
        <input class="form-control" id="last-name" type="text" name="parent-carer-last-name">
    </div>

    <div class="form-group">
        <fieldset>
            <legend>
                <span class="form-label-bold">
                    Date of birth
                </span>
            </legend>

            <div class="form-date form-group form-date-group" data-grouped-inputs>

                <span class="field-validation-error" data-valmsg-for="Child.DateOfBirth.Day" data-valmsg-replace="true"></span>
                <span class="field-validation-error" data-valmsg-for="Child.DateOfBirth.Month" data-valmsg-replace="true"></span>
                <span class="field-validation-error" data-valmsg-for="Child.DateOfBirth.Year" data-valmsg-replace="true"></span>

                <span class="form-hint">For example, 31 03 1980</span>
                <div class="form-group-day" data-grouped-input>
                    <label for="Child.DateOfBirth.Day">Day</label>
                    <input maxlength="2" class="form-control" data-val="true" data-val-number="The field Day must be a number." data-val-range="Day must be between 1 and 31." data-val-range-max="31" data-val-range-min="1" data-val-required="Day field is required" id="Child_DateOfBirth_Day" name="Child.DateOfBirth.Day" type="text" pattern="[0-9]*" inputmode="numeric">
                </div>

                <div class="form-group-month" data-grouped-input>
                    <label for="Child.DateOfBirth.Month">Month</label>
                    <input maxlength="2" class="form-control" data-val="true" data-val-number="The field Month must be a number." data-val-range="Month must be between 1 and 12." data-val-range-max="12" data-val-range-min="1" data-val-required="Month field is required" id="Child_DateOfBirth_Month" name="Child.DateOfBirth.Month" type="text" pattern="[0-9]*" inputmode="numeric">
                </div>

                <div class="form-group-year" data-grouped-input>
                    <label for="Child.DateOfBirth.Year">Year</label>
                    <input maxlength="4" class="form-control" data-val="true" data-val-number="The field Year must be a number." data-val-range="Day must be between 1980 and 2014." data-val-range-max="2014" data-val-range-min="1980" data-val-required="Year field is required" id="Child_DateOfBirth_Year" name="Child.DateOfBirth.Year" type="text" pattern="[0-9]*" inputmode="numeric">
                </div>

            </div>
        </fieldset>

    </div>

    <div class="form-group">
        <label class="form-label-bold">Relationship to the child or children</label>

        <label class="block-label" for="relationship-mother">
            <input id="relationship-mother" type="radio" name="relationship" value="Mother">
            Mother
        </label>

        <label class="block-label" for="relationship-father">
            <input id="relationship-father" type="radio" name="relationship" value="Father">
            Father
        </label>

        <label class="block-label" for="relationship-other" data-target="relationship-other-fields">
        <input id="relationship-other" type="radio" name="relationship" value="Other">
            Other
        </label>
    </div>

    <div class="form-group">
        <label for="phone">
            <span class="form-label-bold">Telephone <span class="unbold">(Optional)</span></span>
        </label>
        <input class="form-control" id="phone" type="text" name="phone">
    </div>

    <div class="form-group">
        <label for="mobile">
            <span class="form-label-bold">Mobile <span class="unbold">(Optional)</span></span>
        </label>
        <input class="form-control" id="mobile" type="text" name="mobile">
    </div>

    <div class="form-group">
        <label for="email">
            <span class="form-label-bold">Email address <span class="unbold">(Optional)</span></span>
        </label>
        <input class="form-control" id="email" type="text" name="email">
    </div>

    <div class="form-group">
        <fieldset>
            <div class="form-group">
                <label>
                    <span class="form-label-bold">Postcode</span>
                </label>
                <input class="form-control" id="postcode" type="text" name="child-postcode">
            </div>
            <div class="form-group">
                <button class="button">Search for address</button>
            </div>
        </fieldset>
    </div>



    <fieldset class="inline">
        <legend>
            <span class="form-label-bold">
                Have you moved in the last 12 months
            </span>
        </legend>
        <div class="form-group form-group-compound">
            <label class="block-label" data-target="moved-last-12-months-fields" for="moved-12-months-yes">
                <input id="moved-12-months-yes" type="radio" name="radio-indent-group" value="Yes">
                Yes
            </label>

            <label class="block-label" for="moved-12-months-no">
                <input id="moved-12-months-no" type="radio" name="radio-indent-group" value="No">
                No
            </label>
        </div>

        <div class="panel-indent js-hidden" id="moved-last-12-months-fields">
            <p class="strong">Enter previous address</p>
            <label for="prev-postcode">
                <span class="form-label-bold">Postcode</span>
            </label>
            <input class="form-control" type="text" id="prev-postcode">
        </div>
    </fieldset>

    <div class="form-group">
        <label for="ni-no">
            <span class="form-label-bold">National Insurance number</span>
        </label>
        <input class="form-control" id="ni-no" type="text" name="ni-no">
    </div>

    <div class="form-group">
        <p class="strong">If you are unable to give us your National Insurance number attach proof of benefit</p>
        <p>Documents accepted with your application:</p>
        <p>For Child Tax Credit a full copy of your current TC602 Tax Credit award notice</p>
        <p>For the following benefits a letter of entitlement dated within the last 6 weeks</p>
        <ul>
            <li>Employment and support allowance (income based)</li>
            <li>Income support</li>
            <li>Job seekers allowance (income based)</li>
            <li>The Guarantee element of state pension credit</li>
            <li>Support under part VI of the immigration and Asylum Act 1999</li>
        </ul>
        <p>All pages of the document must be provided</p>
    </div>

    <div class="form-group">
        <a href="#" class="button">Upload your file</a>
    </div>

    <div class="form-step-buttons">
        <a href="form_2" class="button left">Previous</a>
        <button type="submit" class="button right">Continue</button>
    </div>

</div>
</form>