Care home placement - provide information for a financial assessment

Complete this form to provide information for a financial assessment for a care home placement.

You will need to know the following information before starting this form:

• Resident's social work client reference (This can be found on the letter you will have received, advising you to complete the financial assessment)
• Details of the State benefits the resident receives
• Details on the household expenditure that the resident pays (Only if the resident is currently in an assessment bed or temporary placement in a care home)
• Details for all accounts the resident has held in Banks, Building Societies, the Post Office or any other Financial Institutions

You may need to upload a copy of the following documents within this form:

• letter from the War Pensions (only if receiving income from a War-related pension)
• the last available pension payslip or annual award letter
• bank account statements from the last 6 months, or bank/building society book
• legal document(s) detailing the transfer of a property
• latest mortgage statement

You can find out about how we manage the personal information you provide by reading the privacy policy.