Free School Meal - Fort Pitt Grammar School

4. Full names of children attendingFort Pitt Grammar SchoolDate of BirthFormPlease note - If you have other children attending other schools you MUST complete a separateLEA application form.5. Have you applied for free meals before? YES NO6. STATEMENTPlease read this statement and sign it.Please note - to give false information may result in prosecution.These facts I have put down on this form are true and complete. I give consent for Fort PittGrammar School to make enquiries with the Benefits Agency or HM Revenue and Customs tocheck the information I have given. I will inform the school at once if my family or financialcircumstances change or I gain refugee status.Signed: ........................................................................................... Date: ........................................Thank you for completing this form. Please check that you have put your name and address onthis form. If you have any difficulty please contact Reception.7. INCOME SUPPORT/IBJSA/CHILD TAX CREDITTo be completed by the Benefits Agency responsible for payment of your benefit.I confirm that the above named person has been granted …………………………………………..from ......................................................................... until .................................................................Benefits Agency Official StampSigned: (Manager) ............................................…Date: ...........................................…..Official UseFree School Meals approved from: ....................................................................................................Expiry date of proof of entitlement: ...................................................................................................C:\Users\mbushell\Local Settings\Temporary Internet Files\Content.Outlook\0Y0WX19M\Free Meals Application Form.DOC / 13/02/2013