How to complete this form

Part 1: Security questions

Your answers must be the same as what you told us on your online claim. You will need the following information to hand:

• claim reference number
• national Insurance number

Part 2: Amendment section

You will need the following information to hand:

• type of wages owed, for example salary, overtime or commission
• dates worked and not paid
• your payslip
• details of attachment of earnings

Start part 1