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Residential Status
Home OwnerRented
Are you receiving any benefits?
N/AIncome-based Jobseekers Allowance (JSA)Income related Employment & Support Allowance (ESA)Income Support (IS)Pension Credit Guarantee Credit (PCGC)Working Tax Credit (WTC)Child Tax Credit (CTC)Universal Credit (UC)House BenefitPension Credit Savings Credit
Do you have medical conditions?
N/AA cardiovascular conditionA respiratory diseaseLimited mobilityImmunosuppression
Do you have household income of less than £31,000?
YesNo
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