<commit_before>{% extends "layout.html" %}

{% block page_title %}
  Apply for Employment and Support Allowance (ESA)
{% endblock %}

{% block proposition_header %}
  <!-- blank to remove the proposition header -->
{% endblock %}

{% block header_class %}
  <!-- blank to remove the proposition header -->
{% endblock %}

{% block content %}

<main id="content" role="main">

  <div class="breadcrumbs">
    <ol role="breadcrumbs">
      <li><a href="http://www.gov.uk">Home</a></li>
      <li><a href="https://www.gov.uk/browse/benefits">Benefits</a></li>
      <li><a href="https://www.gov.uk/browse/benefits/disability">Carers and disability benefits</a></li>
    </ol>
  </div>

  <div class="grid-row">
    <div class="column-two-thirds">

      <h1 class="heading-xlarge">
        {% if serviceName %} {{ serviceName }} {% endif %}
      </h1>

      <!-- INTRO NAVIGAITON -->
      <nav class="intro-nav">
        <ol>
          <li class="active font-xsmall">
            <span class="part-number">1.</span>
            <a href="gov-overview" title="Part 2: Eligibility">Overview</a>
          </li>
          <li class="font-xsmall">
            <span class="part-number">4.</span>
            <span>Apply</span>
          </li>
          <li class="font-xsmall">
            <span class="part-number">2.</span>
            <a href="gov-eligibility" title="Part 2: Eligibility">Eligibility</a>
          </li>
          <li class="font-xsmall">
            <span class="part-number">5.</span>
            <a href="gov-circs" title="Part 5: If your circumstances change">If your circumstances change</a>
          </li>
          <li class="font-xsmall">
            <span class="part-number">3.</span>
            <a href="gov-assessed" title="Part 3: What you'll get">How you're assessed</a>
          </li>
        </ol>
      </nav>

      <h2 class="heading-medium">4. Apply</h2>

      <p>Before you apply make sure you have:</p>
      <ul class="list list-bullet">
        <li>your National Insurance number</li>
        <li>a fit note (also known as a sick note or doctor’s note)</li>
        <li>the name, address and telephone number of your GP</li>
        <li>home and mobile telephone numbers</li>
        <li>employers address and telephone number, dates of employment, date SSP ends from SSP1 and final payment details from payslips</li>
        <li>bank, building society or post office account details</li>
        <li>details of any money you are getting</li>
        <li>details of any savings and investments you have</li>
      </ul>

      <div class="panel panel-border-narrow">
        <p>You will be asked to give consent for the Department of Work and Pensions to contact your GP (doctor). If you give consent you may withdraw it at any time</p>
      </div>

      <p>
        <a class="button button-start" href="help-appointee" role="button">Start now</a>
      </p>

      <p>The application will reset if you don’t do anything for more than 30 minutes - you’ll have to restart your application.</p>

      <p>The online service is also available in <a href="#">Welsh (Cymraeg).</a></p>

      <p>You cannot register for this service if you’re in the UK illegally.</p>
      <footer>
        <nav class="pagination" role="navigation" aria-label="Pagination">
          <ul class="group">
            <li class="previous">
              <a href="gov-assessed" rel="prev" title="Navigate to previous part">
                <span class="pagination-label">Previous </span> <span class="pagination-part-title"> How you're assessed</span>
              </a>
            </li>
            <li class="next"><commit_msg>apply page list of req<commit_after>{% extends "layout.html" %}

{% block page_title %}
  Apply for Employment and Support Allowance (ESA)
{% endblock %}

{% block proposition_header %}
  <!-- blank to remove the proposition header -->
{% endblock %}

{% block header_class %}
  <!-- blank to remove the proposition header -->
{% endblock %}

{% block content %}

<main id="content" role="main">

  <div class="breadcrumbs">
    <ol role="breadcrumbs">
      <li><a href="http://www.gov.uk">Home</a></li>
      <li><a href="https://www.gov.uk/browse/benefits">Benefits</a></li>
      <li><a href="https://www.gov.uk/browse/benefits/disability">Carers and disability benefits</a></li>
    </ol>
  </div>

  <div class="grid-row">
    <div class="column-two-thirds">

      <h1 class="heading-xlarge">
        {% if serviceName %} {{ serviceName }} {% endif %}
      </h1>

      <!-- INTRO NAVIGAITON -->
      <nav class="intro-nav">
        <ol>
          <li class="active font-xsmall">
            <span class="part-number">1.</span>
            <a href="gov-overview" title="Part 2: Eligibility">Overview</a>
          </li>
          <li class="font-xsmall">
            <span class="part-number">4.</span>
            <span>Apply</span>
          </li>
          <li class="font-xsmall">
            <span class="part-number">2.</span>
            <a href="gov-eligibility" title="Part 2: Eligibility">Eligibility</a>
          </li>
          <li class="font-xsmall">
            <span class="part-number">5.</span>
            <a href="gov-circs" title="Part 5: If your circumstances change">If your circumstances change</a>
          </li>
          <li class="font-xsmall">
            <span class="part-number">3.</span>
            <a href="gov-assessed" title="Part 3: What you'll get">How you're assessed</a>
          </li>
        </ol>
      </nav>

      <h2 class="heading-medium">4. Apply</h2>

      <p>Before you apply make sure you have:</p>
      <ul class="list list-bullet">
        <li>your National Insurance number</li>
        <li>the name, address and telephone number of your General Practitioner (GP)</li>
        <li>your fit note if you have one (also known as a sick note or doctor’s note)</li>
        <!-- <div class="panel panel-border-narrow"><p>A fit note describes how your condition affects your ability to work and is issued by a hospital doctor or GP.</p></div> -->
        <li>hospital admission date if you’re currently in hospital</li>
        <li>your employer’s address and telephone number</li>
        <li>dates of employment</li>
        <li>your last 2 payslips</li>
        <li>form SSP1 if you have one - your employer should give you an SSP1 if you’re not entitled to Statutory Sick Pay (SSP), or when it’s coming to an end.</li>
        <li>details of any income other than earnings or SSP</li>
        <li>details of your money, savings or investments</li>
        <li>bank, building society or post office account details</li>
      </ul>

      <div>
        <p>You’ll be asked to give consent for the Department of Work and Pensions to contact your GP (doctor). If you give consent you may withdraw it at any time.</p>
      </div>

      <p>
        <a class="button button-start" href="help-appointee" role="button">Start now</a>
      </p>

      <p>The application will reset if you don’t do anything for more than 30 minutes - you’ll have to restart your application.</p>

      <p>The online service is also available in <a href="#">Welsh (Cymraeg).</a></p>

      <p>You cannot register for this service if you’re in the UK illegally.</p>
      <footer>
        <nav class="pagination" role="navigation" aria-label="Pagination">
          <ul class="group">
            <li class="previous">
              <a href="gov-assessed" rel="prev" title="Navigate to previous part">
                <span class="pagination-label">Previous </span> <span class="pagination-part-title"> How you're assessed</span>
              </a>
            </li>
            <li class="next">
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