Apply online for a self-isolation or discretionary payment

Before you begin
This application is for one person only. An application will need to be made for each individual that would like to apply for a payment.

What you'll need

Please make sure you have the following
- National Insurance Number
- Confirmation of the date given by NHS Wales Test, Trace, Protect service (TTP)
- Your most recent Bank Statement, wage slip or proof of self-employment
As well as the above: if you are applying because you have been told to isolate through the NHS Covid-19 App, you will need to provide:
- A screenshot from the NHS Covid 19-App homescreen advising of your isolation period View example screenshot of confirmation from mobile app to self-isolate (opens in new window)
- And either
Who are you completing this application for?
MyselfOn behalf of someone else

Your details
First name
Last name

Applicant details
First name
Last name
Date of birth (DD/MM/YYYY)
National Insurance Number
Email address
Phone number
Your address

Please enter a Denbighshire postcode and then press the ‘Find address’ button.

Alternatively, please type in your address below.
Postcode
Address line 1
Address line 2
Address line 3
Address line 4
Address line 5

NHS Wales Test, Trace, Protect service (TTP)
Have you been asked to self-isolate by NHS Wales Test, Trace, Protect Service (TTP), or through the NHS Covid 19 App because you have been contact with someone who has Covid-19?
YesNo

You cannot complete this form

Unfortunately, you do not meet the criteria for this scheme as you must have been contacted by NHS Wales Test, Trace, Protect service (TTP)

Find out more about the criteria for this scheme

Have you tested positive for Covid-19 or been identified as a close contact of someone else who has?
Positive testClose contact
Please provide the end date of your isolation period?

Employment Details
Please select your employment status:
EmployedSelf-employedNot employed

You cannot complete this form

Unfortunately, you do not meet the criteria for this scheme.

Find out more about the criteria for this scheme

Employment details
Employer name
Employer phone number
Employer address line 1
Employer address line 2
Employer address line 3
Employer address line 4
Postcode
What is the Nature of your Job
Any other information you wish to advise:

Self-employed details
Please outline the nature of your business:

Are you able to work from home during your isolation period?
YesNo

You cannot complete this form

Unfortunately, you do not meet the criteria for this scheme as you are able to work from home during your isolation period.

Find out more about the criteria for this scheme

Will you have a reduction in earned income during this period?
YesNo

You cannot complete this form

Unfortunately, you do not meet the criteria for this scheme.

Find out more about the criteria for this scheme

Which of the benefits/support do you receive?
Universal CreditWorking Tax CreditIncome Based Job Seekers AllowanceIncome SupportIncome Based Employment and Support AllowanceHousing BenefitPension CreditNone

You do not meet the criteria for an isolation payment
You can still be considered for a discretionary payment if you face financial hardship as a result of not being able to work while self-isolating.
Do you wish to continue and apply for a Discretionary Payment?
YesNo

End of application form

You will not receive a payment.

Find out more about this scheme

Evidence documents

Please upload your evidence documents, one by one.

If you do not provide evidence which supports your application it will lead to a delay in processing your claim.

Employed

If you are employed this should include proof of employment e.g. Wages being paid into your Bank Account, or your most recent Wage Slip or Bank Statement

Self-employed

If you are self-employed, please provide evidence of this, such as self-employed accounts which show recent trading or SA302 self assessment form.

In either case please provide your latest bank statements.

Evidence from the NHS Covid-19 App

If your application is because of a notification via the NHS Covid 19 app, you will need to provide the screenshot of the notification, along with evidence from your employer that you did not work during this period. If you do not provide this, your application will be refused.

Example screenshot
Upload evidence document 1
Upload evidence document 2
Upload evidence document 3
Please select one of the following statements that applies to you:
I'm employed and did not work during my isolation periodI'm employed and worked during my isolation periodI am self-employed and did not work during my isolation period.I am self-employed and worked during my isolation period.

You cannot complete this form

Unfortunately, you do not meet the criteria for this scheme.

Find out more about the criteria for this scheme

Bank details
Please provide details of the account you wish the payment to be made to:
Bank account name (name on account)
Bank sort code
Bank account number

The next set of questions asks about your personal characteristics. This is to help us understand the take up of the scheme among different groups of the population. Where possible, these questions have been aligned with those used by the Office for National Statistics (ONS).
What is your date of birth? (DD/MM/YYYY)
What is your sex?
MaleFemaleOther
Ethnicity
What is your ethnic group? Choose one option that best describes your ethnic group or background.
White
Welsh / English / Scottish / Northern Irish / BritishIrishGypsy or Irish Traveller
Any other White background, please describe:
Mixed or Multiple ethnic groups
White and Black CaribbeanWhite and Black AfricanWhite and Asian
Any other Mixed or Multiple ethnic background, please describe:
Asian or Asian British
IndianPakistaniBangladeshiChinese
Any other Asian background, please describe:
Black or Black British
AfricanCaribbean
Any other Black, African or Caribbean background, please describe:
Any other ethnic group
ArabOther
Any other ethnic group, please describe:
Disability
Do you have any physical or mental health conditions or illnesses lasting or expected to last 12 months or more?
YesNo
If yes, do any of your conditions or illnesses reduce your ability to carry out day-to-day activities?
Yes, a lotYes, a littleNot at all

As part of making this application, please note that Welsh Government, or a research company employed by them may invite you to take part in follow up research. This would involve passing your contact details to Welsh Government. Your details will only be used for research purposes and your personal details will be kept completely confidential. If you are re-contacted there will be no obligation to take part. Would you be willing to be re-contacted
YesNo
Declaration

I confirm that this information is true and accurate. I agree to stay at home and self-isolate for the required period. I understand that if I fail to do so, I will be required to pay the funds back and my contact details maybe passed onto the police for further action.

Please note the information provided on this form will be verified and if details found to be incorrect no payment will be made.
Please check the box to confirm that you agree to the above declaration.
I agree to the above declaration

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Apply online for a self-isolation or discretionary payment

What happens to my information?

What you'll need

Employed

Self-employed

Evidence from the NHS Covid-19 App

Example screenshot

Tell us whether you accept cookies

What happens to my information?

What you'll need

Employed

Self-employed

Evidence from the NHS Covid-19 App

Example screenshot

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