A guided, printable template for the partner, family member or friend who helps you - so what they see every day becomes signed, first-hand evidence for your ESA or UC health claim.
Medical letters prove your diagnosis. But the Work Capability Assessment is decided on how you manage everyday activities, the majority of the time - and the person who cooks for you, reminds you, steadies you and picks up the pieces on bad days sees that better than any clinic. The problem: most carers have no idea what to write, so this evidence never gets sent. This template fixes that with guided prompts for every area of daily life.
What is inside
Prompts for every areaFood, medication, washing, dressing, letters and phone calls, concentration and finishing tasks, going out alone and moving around - a question for each, so your carer describes what they actually do and see, in their own words.
How-often tick boxesEvery day, most days, a few times a week - the frequency boxes match the "majority of the time" principle WCA decisions are made on.
Space for dated examplesThree witnessed incidents with dates - falls, blackouts, panic attacks, missed medication, days that stopped everything. Dated first-hand incidents are also the strongest support for the substantial-risk route to the Support Group.
Declaration + where to send itA signed declaration page, plus exactly where the statement goes: with the ESA50 or UC50 form, at a reassessment, before an assessment, or at mandatory reconsideration and appeal.
Get the template free
Enter your email and the PDF downloads straight away. Print one for each person who helps you - more than one statement is fine.
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Give it to the person who helps you most. Ask them to read your form answers first, write in their own words, and sign and date the last page.
Tip: pair it with the free Symptom & Bad Days Diary - the diary records what you live, the statement records what they see.
Why a carer's statement carries weight
The WCA is decided on paper plus a relatively short assessment, while your carer sees the other twenty-nine days of the month. Their account works because it is first-hand ("I cook his evening meal" rather than "he cannot cook"), specific (how often, since when, with dates), and consistent with what you wrote on your WCA50. It is strongest exactly where claims are hardest to prove - mental health, fatigue and fluctuating conditions - and a dated account of witnessed incidents also supports the substantial-risk route to the Support Group. Our full guide to the carer's statement for ESA covers the detail, and it sits naturally alongside the rest of your ESA evidence.
Nobody needs formal status to write one. A partner, parent, adult child, friend, neighbour or support worker all count, whether or not they receive Carer's Allowance - and if you are a carer with your own health conditions, see ESA for carers.
Their statement supports the claim. The form wins it.
The WCA50 form is where most decisions are really made. See free how a strong answer about your own conditions reads - before you decide anything.
Is the ESA carer's statement template really free?+
Yes. Enter your email and the PDF downloads straight away - no payment, no card details. We fund it through our paid ESA guidance service. We may send occasional ESA guidance emails, and you can unsubscribe at any time.
Who can write a carer's statement for ESA?+
Anyone who genuinely helps or sees you regularly: a partner, parent, adult child, friend, neighbour or paid support worker. They do not need any formal status, do not need to live with you, and do not need to receive Carer's Allowance. More than one person can each write their own statement.
Does a carer's statement help at the Work Capability Assessment?+
It can. The WCA is decided on written evidence plus a relatively short assessment, while your carer sees the majority of days: the reminders, the help, the crashes after activity. A signed statement that is specific, dated and consistent with your WCA50 answers puts what they witness on the record, and decision makers and tribunals can weigh it as evidence.
Where do I send a carer's statement for ESA or UC?+
Send it with the ESA50 or UC50 form, or after with your name and National Insurance number on it. Before an assessment it can go to the assessment provider, and at mandatory reconsideration or appeal it goes to the DWP or the tribunal. Send a copy rather than the only original.