Apply online for a self-isolation or discretionary payment

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

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?

You cannot complete this form

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

Find out more about the criteria for this scheme

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

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

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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