Not come across that scenario as yet, but my thoughts are…
Use the claim form you already have for the Mar – Jul 04 period, then get a separate form for the Nov period (no rush, he’s got another 7 months to make this claim 😉 ).
I’m trying to think of ways that you could do it with just the singular form but I’m struggling to come up with ways to do it. The only option that I’m seeing a potential argument in is the fact that you have not yet decided the claim, and whether a known period of nil-entitlement can be taken account of.
If you had superseded the award to nil then you must have a new claim to award benefit for a later period but in your case there is no award to supersede. Not convinced myself, hence my advice to get a second form.