Pupil

First name*

Surname*

Date of Birth*

Parent/Carer

First name*

Surname*

Date of birth*

Email address*

Contact number

National Insurance No*

I declare that the information I have given here is true and complete, and I agree that I will inform the school of any changes to my financial circumstances. I also understand that failure to do so may result in my repaying the full cost of meals from the date of change.

I agree that you will use the information I have provided to process my claim for free school lunches and will contact other sources as allowed by the law to verify my initial, and ongoing, entitlement.

I understand that the results of any free school lunch eligibility check may also be used to assess my entitlement to further ‘benefits’ should they be appropriate.

I have read and agree with the above terms of this declaration.

Data Protection Act 1998

WARNING: The Authority is under a duty to protect the public funds it administers and to this end may use the information you have provided on this form within its Authority for the prevention and detection of fraud. It may also share this information with other bodies administering public funds solely for these purposes.