Looking at this card, are you at present receiving any state benefits in your own right: that is, where you are the named recipient?

Child Benefit
Guardian’s Allowance
Carer’s Allowance
Retirement pension (National Insurance), or Old Person’s pension
Widow’s pension, Bereavement Allowance or Widowed Parents (formerly Widowed Mother’s) Allowance
War Disablement Pension or War Widow’s/Widower’s Pension
(and any related allowances)
Severe Disablement Allowance
None of these