CUSTOMER ACCOUNTS SELF EMPLOYED EARNINGS INFORMATION
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1 CUSTOMER ACCOUNTS SELF EMPLOYED EARNINGS INFORMATION Housing Benefit and Council Tax Benefit Central Bedfordshire Council Watling House High Street North Dunstable Bedfordshire LU6 1LF Please complete this form and return it to the address above to: Provide proof of your self-employed earnings if you do not have accounts. If you have any questions about this form, please contact us: Telephone Section 1 About yourself Title First names Surname Address Postcode Name of business Business Address Section 2 About your business Postcode Business phone no. Type of business Date business started / / Start date of your current financial year / / Average hours worked per week Is your business a partnership? If yes, what percentage of the total profit/loss is yours?
2 Is your partner (i.e husband / wife / civil partner / person you live with as if you were their husband or wife) a business partner? If yes, what percentage of the profit/loss is theirs? Is your partner on the business payroll? If yes, what are their earnings? every Please name any other people on the payroll and the amount they are paid. Section 3 About your business income National Insurance Do you hold an exemption certificate? If yes, please send it in with this form. Do you have your latest schedule D Tax assessment? If yes, please send it in with this form. Do you have prepared accounts? If yes, please send in an original set of these with this form and go to Section 5 and 6. If no, please state the reason why and the date you expect to receive them. If you do not have any prepared accounts for the last financial year or have been trading for less than a year, please complete Section 4. If your business has recently started trading you may be requested to enter details for projected income and expenditure.
3 Section 4 Details of income and expenditure Please complete this section with details covering the period to Income Received Total Sales / Takings / Income Tips /Gratuities / Royalties Invoices raised not paid VAT refunds Closing stock Expenditure Purchases VAT paid out Drawings (cash or stock) Opening stock Wages paid To self To partner To others Vehicles Do you run a vehicle(s) solely for the purpose of your business? e.g. a van or lorry Do you run a vehicle that is used for both business and personal use? Vehicle expenses Total Percentage business use Petrol / Diesel Maintenance Road Tax Vehicle Insurance
4 Vehicle hire and leasing charges Vehicle repairs Hackney licence i.e. Taxis Premises Do you use a room(s) in your home for the purposes of your business? If no, do not complete the questions below about rooms and property outgoings. If yes, how many rooms? What is the total number of rooms in your property, excluding toilets and bathrooms? Do you own or rent separate premises for your business? Property outgoings Home total Business property total Rent / Mortgage interest payments Business rates Water rates Heating Lighting Building insurance Insurance Public liability Insurance Insurance to cover the cost or repair and replacement of a business asset Business Loans Purpose of loan Amount of loan Repayment period Capital amount repayable Monthly interest Please enclose a copy of the loan agreement.
5 Other Expenses Type of expense Total Business percentage Advertising Printing and Stationary Postage, carriage and delivery costs Telephone Bank charges Business, legal and accountancy fees Bad Debts (where legal action for recovery has been taken and the debt is over 12 months old) Repair and replacement of business assets (do not include motoring). Please give details... Business entertainment Leasing charges (do not include motoring) Any other expenses please specify You may be contacted to supply evidence of some of the expenses detailed above. Section 5 Personal pension schemes If you contribute into a personal pension scheme please state: Amount paid Frequency (e.g. weekly, monthly) Please send in proof of these payments.
6 Section 6 Declaration Please read this declaration carefully before you sign and date it. I understand the following: I declare that the information I have given on this form is correct and complete as far as I know and believe. I understand that if I knowingly give information that is incorrect or incomplete, I may be liable to prosecution or other action. I agree that you will use the information provided to process my claim for Housing Benefit or Council Tax Benefit or both. You may check some of the information with other sources as allowed by the law. I will contact Customer Accounts to advise of any changes that may affect my claim. I declare that the information I have given on this form is correct and complete. Signature Date
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