A sample PIP evidence pack

Sam Rowe 25 October 2026

Functional Evidence Statement in support of my PIP claim

I live with Ehlers-Danlos syndrome or hypermobility spectrum disorder. This statement describes how those conditions affect my ability to carry out each of the PIP activities I have difficulty with, and how reliably I can carry them out. Please read this statement against what I can do on most days, not against what I can manage on a good day.

Preparing food

I cannot stand at the cooker for more than about five minutes before my knees and hips hurt and I feel dizzy. I sit on a stool to chop, so I need to use an aid to be able to prepare a simple meal. My grip is weak and I have dropped pans. I cannot lift a full kettle or a pan of water.

I cannot cook safely. I have burnt my hand twice this year when my wrist gave way. I cannot cook to an acceptable standard, because I cannot stay at the cooker without pain and dizziness setting in after about five minutes. For the same reason I cannot cook within a reasonable time period, and I cannot cook repeatedly, as often as meals are needed.

On most days I need my partner's assistance to cook a simple meal. On those days I eat microwave meals or my partner cooks for me.

Washing and bathing

I need to use an aid to be able to wash or bathe. I shower sitting on a shower stool because standing makes me dizzy and my knees give way, so I cannot shower safely while standing. I cannot get in or out of the bath at all.

On bad days, about four days a week, I need assistance to be able to get in or out of the shower, and my partner helps me.

Washing my hair makes my shoulders ache, and I have to stop and rest my arms before I can carry on. This pain and the pauses affect whether I can wash to an acceptable standard and within a reasonable time period. After showering I need to lie down for half an hour, so I cannot wash and then carry straight on with my day. This affects whether I can wash repeatedly, as often as I reasonably need to.

Moving around

I can stand and then move using an aid or appliance for no more than about 50 metres. I use a walking stick outside. At about 50 metres the pain in my hips and knees makes me stop, and covering that distance takes me about two minutes. For anything further I use a wheelchair, which my partner pushes. Most mornings my joints are stiff and my knees and hips ache, and it takes me about an hour before I can move around properly. Standing still for more than a few minutes makes me dizzy, so I sit down whenever I can.

I cannot walk this distance safely on every surface, because my ankles roll on uneven ground. I do not walk it to an acceptable standard either, as pain in my hips and knees is what forces me to stop. I cannot do it repeatedly, because after a walk I need to rest for the rest of the morning, and so I cannot walk again later in the morning. Taking about two minutes to cover 50 metres means I also cannot do it within a reasonable time period.

I ask that each activity is considered under the reliability test, that is whether I can carry it out safely, to an acceptable standard, repeatedly, and within a reasonable time period, and that it is considered on the majority of days rather than on a single good day.

Signed:

Sam Rowe Date: 25 October 2026

This document is general information and document drafting, not benefits advice. It was not produced by, and is not affiliated with, the Department for Work and Pensions or the NHS. No award is guaranteed. Please check current guidance at gov.uk before sending anything to the DWP.

Sam Rowe 25 October 2026

The Practice Manager [Your GP practice name and address]

Subject: Subject access request under Article 15 UK GDPR

Dear Practice Manager,

I am writing to make a subject access request for my medical records held by your practice. I am requesting these records as evidence for a Personal Independence Payment (PIP) claim.

Under Article 15 of the UK General Data Protection Regulation, I have the right to a copy of the personal data you hold about me. This request is free of charge and must be responded to within one month.

Please provide the following: 1. A complete copy of my GP electronic record, or 2. If a full record is not practical, an extract covering the period from the onset of Ehlers-Danlos syndrome or hypermobility spectrum disorder to today, including consultations, referrals, letters from secondary care, prescribed medications, and any relevant test results.

If you can also provide this in a searchable PDF or via the NHS App online records feature, that would be helpful, but I am content to receive it in whichever format is easiest for your practice.

I confirm my identity below: - Full name: Sam Rowe - Email: [your email address]

If you require additional identity verification, please contact me at the details above.

Yours sincerely,

Sam Rowe

This document is general information and document drafting, not benefits advice. It was not produced by, and is not affiliated with, the Department for Work and Pensions or the NHS. No award is guaranteed. Please check current guidance at gov.uk before sending anything to the DWP.

Sam Rowe 25 October 2026

[Your GP practice name and address]

Subject: Request to confirm specific facts on my medical record for a PIP claim

Dear Doctor,

I am submitting a Personal Independence Payment (PIP) claim. This is a request for you to confirm SPECIFIC factual points that are already recorded in my notes, rather than a general supporting letter. Confirming facts already on the record should take only a few minutes and is more useful to the DWP than a narrative letter.

Please could you confirm, in writing addressed to me and added to my medical record:

1. Diagnoses currently on my record that are relevant to my PIP claim, in particular: Ehlers-Danlos syndrome or hypermobility spectrum disorder. 2. Any medications prescribed for those conditions, with the current dose and start date. 3. The approximate number of consultations I have had for these conditions with this practice. 4. Whether I have been referred to secondary care for any of these conditions, and if so, the specialty and referral date. 5. Any documented functional impact recorded in my notes (for example: work-related fit notes, hospital admissions, or clinician observations about day-to-day function).

I am NOT asking you to make any judgement about my entitlement to PIP, or to describe my function beyond what is already on the record. The DWP assessor will make functional judgements on the basis of the evidence I supply.

I understand some practices charge a private fee for supporting letters. I would prefer, where possible, to receive this confirmation as an addition to my medical record without a private fee. If your practice's policy requires a fee, please let me know the amount before proceeding.

For completeness: I have also made a subject access request under Article 15 UK GDPR for a copy of my medical records, which is free and must be responded to within one month. The records request is my primary route to evidence; this confirmation letter is a lighter-touch supplement.

Yours sincerely,

Sam Rowe

This document is general information and document drafting, not benefits advice. It was not produced by, and is not affiliated with, the Department for Work and Pensions or the NHS. No award is guaranteed. Please check current guidance at gov.uk before sending anything to the DWP.

Sam Rowe 25 October 2026

Seven-Day Diary for my PIP claim

How to use this diary - Fill in one page per day for seven consecutive days. - Do not exaggerate. Do not minimise. Write it exactly as it happens. - Where possible, use the reliability language below when describing an activity: * Safely: could you do it in a way unlikely to cause harm to you or to anyone else, either while you do it or afterwards. * To an acceptable standard: was the result actually good enough: food edible and safely cooked, you actually clean, clothes appropriate, nothing needing redoing by someone else, and not at the cost of being unable to manage the rest of the day. * Repeatedly: could you do it again, as often as it reasonably needs doing. * Within a reasonable time: did it take you more than twice as long as the longest it would normally take someone without your condition. - Quantified frequency: your default frame for this diary is "on most days", but replace it with real counts as you go. - Attach this diary to your PIP2, mandatory reconsideration bundle, or tribunal bundle. Keep the original.

Day 1 (date: __________)

Which activities I attempted today: - Preparing food: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it. - Washing and bathing: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it. - Moving around: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it.

Reliability of the hardest activity today: - Safely (any risk of harm today? to me or anyone else?): - To an acceptable standard (was the result actually good enough, or did it need redoing or putting right?): - Repeatedly (could I do it again if I had to?): - In a reasonable time (did it take more than twice as long as it would for someone without my condition?):

Anything I could NOT do today that I would normally be expected to do:

Notes / evidence I can attach (photos of missed meals, unopened post, unwashed dishes, care alerts, etc.):

Day 2 (date: __________)

Which activities I attempted today: - Preparing food: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it. - Washing and bathing: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it. - Moving around: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it.

Reliability of the hardest activity today: - Safely (any risk of harm today? to me or anyone else?): - To an acceptable standard (was the result actually good enough, or did it need redoing or putting right?): - Repeatedly (could I do it again if I had to?): - In a reasonable time (did it take more than twice as long as it would for someone without my condition?):

Anything I could NOT do today that I would normally be expected to do:

Notes / evidence I can attach (photos of missed meals, unopened post, unwashed dishes, care alerts, etc.):

Day 3 (date: __________)

Which activities I attempted today: - Preparing food: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it. - Washing and bathing: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it. - Moving around: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it.

Reliability of the hardest activity today: - Safely (any risk of harm today? to me or anyone else?): - To an acceptable standard (was the result actually good enough, or did it need redoing or putting right?): - Repeatedly (could I do it again if I had to?): - In a reasonable time (did it take more than twice as long as it would for someone without my condition?):

Anything I could NOT do today that I would normally be expected to do:

Notes / evidence I can attach (photos of missed meals, unopened post, unwashed dishes, care alerts, etc.):

Day 4 (date: __________)

Which activities I attempted today: - Preparing food: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it. - Washing and bathing: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it. - Moving around: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it.

Reliability of the hardest activity today: - Safely (any risk of harm today? to me or anyone else?): - To an acceptable standard (was the result actually good enough, or did it need redoing or putting right?): - Repeatedly (could I do it again if I had to?): - In a reasonable time (did it take more than twice as long as it would for someone without my condition?):

Anything I could NOT do today that I would normally be expected to do:

Notes / evidence I can attach (photos of missed meals, unopened post, unwashed dishes, care alerts, etc.):

Day 5 (date: __________)

Which activities I attempted today: - Preparing food: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it. - Washing and bathing: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it. - Moving around: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it.

Reliability of the hardest activity today: - Safely (any risk of harm today? to me or anyone else?): - To an acceptable standard (was the result actually good enough, or did it need redoing or putting right?): - Repeatedly (could I do it again if I had to?): - In a reasonable time (did it take more than twice as long as it would for someone without my condition?):

Anything I could NOT do today that I would normally be expected to do:

Notes / evidence I can attach (photos of missed meals, unopened post, unwashed dishes, care alerts, etc.):

Day 6 (date: __________)

Which activities I attempted today: - Preparing food: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it. - Washing and bathing: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it. - Moving around: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it.

Reliability of the hardest activity today: - Safely (any risk of harm today? to me or anyone else?): - To an acceptable standard (was the result actually good enough, or did it need redoing or putting right?): - Repeatedly (could I do it again if I had to?): - In a reasonable time (did it take more than twice as long as it would for someone without my condition?):

Anything I could NOT do today that I would normally be expected to do:

Notes / evidence I can attach (photos of missed meals, unopened post, unwashed dishes, care alerts, etc.):

Day 7 (date: __________)

Which activities I attempted today: - Preparing food: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it. - Washing and bathing: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it. - Moving around: what happened, how long it took, whether you needed help, whether it was safe, how many times you had to redo it.

Reliability of the hardest activity today: - Safely (any risk of harm today? to me or anyone else?): - To an acceptable standard (was the result actually good enough, or did it need redoing or putting right?): - Repeatedly (could I do it again if I had to?): - In a reasonable time (did it take more than twice as long as it would for someone without my condition?):

Anything I could NOT do today that I would normally be expected to do:

Notes / evidence I can attach (photos of missed meals, unopened post, unwashed dishes, care alerts, etc.):

Summary at the end of the week: - The activity that most consistently failed the reliability test: __________ - Days out of 7 that this activity failed at least one of the four reliability criteria: __________ - The single day that best illustrates my typical functioning: __________

This document is general information and document drafting, not benefits advice. It was not produced by, and is not affiliated with, the Department for Work and Pensions or the NHS. No award is guaranteed. Please check current guidance at gov.uk before sending anything to the DWP.

Sam Rowe 25 October 2026

Companion statement, two blank copies

Who this is for Someone who sees Sam Rowe on a bad day: a partner, a family member, a friend, a carer, or a support worker. Two blank copies are enclosed so that two different people can each write one, or so that one person can start again.

How to fill it in - Write in your own words. Do not copy their statement, and do not read it first if you can avoid it. - Only write what you have seen yourself. If you have not seen something, leave it blank. - A short honest statement carries more weight than a long one. - Say how often you see them, and in what circumstances. Someone who sees them twice a week is telling the DWP something different from someone who lives with them. - Do not say whether you think they should get anything. That is not what you are being asked.

The words the DWP uses Use these only where they match what you have actually seen.

Preparing food Can prepare and cook a simple meal unaided. Needs to use an aid or appliance to be able to either prepare or cook a simple meal. Cannot cook a simple meal using a conventional cooker but is able to do so using a microwave. Needs prompting to be able to either prepare or cook a simple meal. Needs supervision or assistance to either prepare or cook a simple meal. Cannot prepare and cook food.

Washing and bathing Can wash and bathe unaided. Needs to use an aid or appliance to be able to wash or bathe. Needs supervision or prompting to be able to wash or bathe. Needs assistance to be able to wash either their hair or body below the waist. Needs assistance to be able to get in or out of a bath or shower. Needs assistance to be able to wash their body between the shoulders and waist. Cannot wash and bathe at all and needs another person to wash their entire body.

Moving around Can stand and then move more than 200 metres, either aided or unaided. Can stand and then move more than 50 metres but no more than 200 metres, either aided or unaided. Can stand and then move unaided more than 20 metres but no more than 50 metres. Can stand and then move using an aid or appliance more than 20 metres but no more than 50 metres. Can stand and then move more than 1 metre but no more than 20 metres, either aided or unaided. Cannot, either aided or unaided, - (i) stand; or (ii) move more than 1 metre.

Companion statement about Sam Rowe Copy 1 of 2

About you Your full name: ______________________________ Your relationship to Sam Rowe: ______________________________ How long you have known them: ______________________________ How often you see them, and where: ______________________________ Are you paid to care for them? Yes or no: __________

What you have seen Preparing food What you have seen Sam Rowe unable to do: ______________________________ ______________________________ What help you actually give, and how often: ______________________________ ______________________________ What happens to them afterwards: ______________________________ ______________________________

Washing and bathing What you have seen Sam Rowe unable to do: ______________________________ ______________________________ What help you actually give, and how often: ______________________________ ______________________________ What happens to them afterwards: ______________________________ ______________________________

Moving around What you have seen Sam Rowe unable to do: ______________________________ ______________________________ What help you actually give, and how often: ______________________________ ______________________________ What happens to them afterwards: ______________________________ ______________________________

A bad day and a better day On a bad day, what you see: ______________________________ ______________________________ On a better day, what you see: ______________________________ ______________________________ How often the bad days come, in your own words: ______________________________

One thing you have witnessed yourself What happened, and roughly when: ______________________________ ______________________________ Who else was there: ______________________________ What they could not do afterwards: ______________________________

Declaration Everything written above is what I have seen myself. I have written it in my own words. I have not copied anyone else's account, and I have not written anything I am not sure about.

Signed: ______________________________ Print your name: ______________________________ Date: ____ / ____ / ________

Companion statement about Sam Rowe Copy 2 of 2

About you Your full name: ______________________________ Your relationship to Sam Rowe: ______________________________ How long you have known them: ______________________________ How often you see them, and where: ______________________________ Are you paid to care for them? Yes or no: __________

What you have seen Preparing food What you have seen Sam Rowe unable to do: ______________________________ ______________________________ What help you actually give, and how often: ______________________________ ______________________________ What happens to them afterwards: ______________________________ ______________________________

Washing and bathing What you have seen Sam Rowe unable to do: ______________________________ ______________________________ What help you actually give, and how often: ______________________________ ______________________________ What happens to them afterwards: ______________________________ ______________________________

Moving around What you have seen Sam Rowe unable to do: ______________________________ ______________________________ What help you actually give, and how often: ______________________________ ______________________________ What happens to them afterwards: ______________________________ ______________________________

A bad day and a better day On a bad day, what you see: ______________________________ ______________________________ On a better day, what you see: ______________________________ ______________________________ How often the bad days come, in your own words: ______________________________

One thing you have witnessed yourself What happened, and roughly when: ______________________________ ______________________________ Who else was there: ______________________________ What they could not do afterwards: ______________________________

Declaration Everything written above is what I have seen myself. I have written it in my own words. I have not copied anyone else's account, and I have not written anything I am not sure about.

Signed: ______________________________ Print your name: ______________________________ Date: ____ / ____ / ________

This document is general information and document drafting, not benefits advice. It was not produced by, and is not affiliated with, the Department for Work and Pensions or the NHS. No award is guaranteed. Please check current guidance at gov.uk before sending anything to the DWP.

Sam Rowe 25 October 2026

What to send, and when

If you already have a decision you disagree with Ask for a mandatory reconsideration now, within one calendar month of the date printed on your decision letter. You do not need this pack, or any other evidence, to be ready first. You can send your evidence after you have asked. If you miss that month, it becomes much harder to challenge the decision at all.

Your plan TODAY (25 October 2026): read your statement, correct anything that is not true of you, and sign it. THIS WEEK: start your Seven-Day Diary, give the Companion Statement to someone who sees you on a bad day, and send the GP records request, because records take the longest to come back. WHEN YOUR RECORDS ARRIVE: pick out only the pages that mention your conditions, your medication, your referrals, or how you manage day to day. Send those pages, not the whole record. BY YOUR DEADLINE: write your deadline here once you know it: __________. If you have had a decision you disagree with, it is one calendar month from the date printed on your decision letter. Send it before that date. Do not wait for anything that has not arrived.

Two warnings, before anything else 1. Do not send your whole medical record. Send only the pages that speak to the activities you are describing. A decision maker reading forty pages of blood results is not reading your statement. 2. Send it by a method that gives you proof, and keep a copy of everything you send. Ask for proof of posting, or send it signed for. If you send it online, keep the confirmation.

How big the bundle should be A focused bundle of roughly five to ten pages gets read. A large stack gets skimmed. Order it like this: your signed statement, your Seven-Day Diary, any completed Companion Statement, then the one or two pages of medical evidence that add something new.

Where to get evidence, what it costs, and how long it takes

Your GP record, by subject access request How: the records request letter in this pack, signed and sent to your practice. Cost: free. A charge cannot be made for a first copy. How long: one calendar month. Supports: every activity, because it is where fit notes, referrals and letters live.

Your GP record, through the NHS App How: open the NHS App and look for your health record. Cost: free. How long: immediately, if your practice has switched record access on. If it has not, ask them, and send the records request letter as well. Supports: medication, consultations, and the dates of both.

A printout of your medication from your pharmacy How: ask at the counter for a printout of your current repeat medication. Cost: usually free. Ask first. How long: usually the same day. Supports: managing medication and treatment, and any activity affected by side effects.

Your hospital record, by a separate request How: the same kind of request, addressed to the records or information governance team at the trust, not to your GP. It is a separate organisation and a separate request. Cost: free. How long: one calendar month. Supports: admissions, clinic letters, therapy assessments.

Paperwork already in your house How: look through what you already have, and use this three-line test on each page. Keep it if it says what you cannot do, or what help you need. Keep it if it is dated and names your condition. Drop it if it only proves an appointment happened. Cost: nothing. How long: an hour, on a day when you can manage it. Supports: whatever it names.

Proof of the aids and the support you already have How: find the paperwork you were given. An occupational therapy report, a blue badge, a wheelchair service letter, disabled facilities grant paperwork, a care needs assessment, or the outcome letter from a Universal Credit or ESA work capability assessment. Cost: nothing, because you already have it. Ask the issuing service for a copy if you do not. How long: the same day, if it is in the house. Supports: aids and appliances, help from another person, and moving around.

What to write on the PIP2 form Match the box by its title, not its number: the numbering changes between versions of the form.

Where the form asks about "Preparing food": write "see the section headed Preparing food in my attached Functional Evidence Statement", then add anything the box asks for that is not in it.

Where the form asks about "Washing and bathing": write "see the section headed Washing and bathing in my attached Functional Evidence Statement", then add anything the box asks for that is not in it.

Where the form asks about "Moving around": write "see the section headed Moving around in my attached Functional Evidence Statement", then add anything the box asks for that is not in it.

The four reliability criteria, in plain words The form and the assessment are meant to ask whether you can do each activity safely, to an acceptable standard, repeatedly, and in a reasonable time. Answer all four for each activity, in your own words. Safely: could you do it without a real risk of harm to you or anyone else, during it or afterwards. To an acceptable standard: was the result actually good enough. Was the food edible and safely cooked. Were you actually clean. Did someone have to redo it or put it right. Did doing it cost you the rest of the day. Repeatedly: could you do it again, as often as it reasonably needs doing. In a reasonable time: did it take you more than twice as long as the longest it would normally take someone without your condition.

About your record A record with gaps is still evidence. If you were too unwell to write, note that, because a blank day for that reason is itself evidence about how you are. Send it as it is.

If you are refused, do not stop at the reconsideration stage A mandatory reconsideration can change the award, and an appeal to an independent tribunal is a further step. If the reconsideration decision is still one you disagree with, you have one calendar month from the date on the mandatory reconsideration notice to appeal.

What is on your record with us Your name: Sam Rowe Your conditions: Ehlers-Danlos syndrome or hypermobility spectrum disorder If any of that is wrong, tell us and we will redraft the documents free.

This document is general information and document drafting, not benefits advice. It was not produced by, and is not affiliated with, the Department for Work and Pensions or the NHS. No award is guaranteed. Please check current guidance at gov.uk before sending anything to the DWP.