If you were getting one of the listed benefits, tick this box and the box next to the benefit you received.
If you are the partner, a dependant child or young person under 20 years old of someone who was getting one of the listed benefits, tick this box and write the name and date of birth of the person receiving the benefit. Also tick the box next to the benefit they received.
If you tick the box for Universal Credit, Income Support, Income-based Jobseeker's Allowance or Income-related Employment and Support Allowance send your HC5(W) form to your local Jobcentre Plus office.
You can find your local office online at https://find-your-nearest-jobcentre.dwp.gov.uk/
If you tick the box for Pension Credit Guarantee Credit, send your HC5(W) form to the Pension Centre who dealt with your claim.