You can see the DLA section on direct.gov.uk or the new print and fill out DLA1 ADULT October 2011

Declaration

We cannot pay any benefit until you have signed the declaration and returned the form
to us. Please return the signed form straight away.

I declare that the information I have given on this form is correct and complete as far as
I know and believe.

I understand that if I knowingly give false information, my benefit may be stopped and
I may be liable to prosecution or other action.

I understand that I must promptly tell the office that pays my Disability Living Allowance
of anything that may affect my entitlement to, or the amount of, that benefit.

I understand that the Department for Work and Pensions may use the information
which it has now or may get in the future to decide whether I am entitled to:
•  the benefit I am claiming
•  any other benefit I have claimed
•  any other benefit I may claim or be awarded in the future.

This is my claim for Disability Living Allowance.
Signature

Print your name here
Date    /              /

How we collect and use information

The information we collect about you and how we use it depends
mainly on the reason for your business with us. But we may use it for
any of the Department’s purposes, which include:
•  social security benefits and allowances
•  employment and training
•  private pensions policy, and
•  retirement planning

We may get information from others to check the information you give
to us and to improve our services.

We may give information to other organisations as the law allows, for
example to protect against crime.

To find out more about how we use information, visit our website
www.dwp.gov.uk/privacy-policyor contact any of our offices.