Statement of Relationship - Couple living separately due to illness

Form ID: 
D9157
Audience: 
General

The information sought on this form is used to determine whether you are a member of an illness separated couple or whether you are no longer in a married or marriage-like relationship for the purposes of assessing your income support payments.

If you are using an Apple computer and want to fill out your form electronically, please download the form and open it with Acrobat 7 or later.

How can I access this form?: 
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