Always complete items A-C.
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Item A - Enter the first name(s), middle and last name of the worker. If applicable,
show the worker's maiden name after the last name.
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Item B - Enter the worker's U.S. Social Security number.
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Item C - Enter the worker's U.K. National Insurance Number as shown on the application
form or on the U.K. liaison form.
NOTE: The number consists of a two-letter alpha prefix, followed by a six-digit serial number
and ending with a single alpha suffix, e.g. TK 987654 A.
Complete items D and E if you are transmitting a claim or protective filing date to
the U.K. agency.
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Item D - Enter the type of U.K. benefits that are being claimed.
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Item E - Enter the filing date to be certified to the U.K. agency.
Always complete item F unless you are responding to an assistance request from a U.K.
agency.
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Item F - Enter the claimant's name only if the claimant is not the worker. Always
enter the claimant's address.