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Notes to read before you fill in this form.
Unfortunately there is not an automatic right to have your claim backdated. You must give good reason as to why you did not fill in a form at the right time. For benefit to be backdated you must prove continuous "good cause".

Good cause has been defined by a social security commissioner as meaning:

"Some fact which having regard to all the circumstances including the claimant's state of health and all the information which he had received and that he might have obtained, would probably have caused a reasonable person of his/her age and experience to act or fail to act as the claimant did."

To consider your request you must give full and detailed reasons as to why you did not apply at the appropriate time, and why you feel that your benefit should be backdated: i.e. you must provide good cause.

You must tell the benefit section straight away if anything changes. If you are not sure if it affects your benefit, then tell the benefit section anyway. To prevent losing benefit you must tell us about your change in circumstances within one calendar month of the date of the change.

To complete a Request for Backdated Benefit you will need:
- your Benefit Case Reference Number
- Your National Insurance Number