Self-Employed Earnings Information Form

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1 1 Claim reference number Self-Employed Earnings Information Form Please fill in this form if you or your partner is self-employed. If you are both self-employed in different businesses you should each complete a Self-Employed Earnings Information Form. We need to know about your income, so that we can work out your Housing Benefit/Council Tax Reduction. Please answer all the questions on this form and give details of all your business income and expenditure. Please provide supporting documents, such as your most recent year s tax assessment, business bank account statements, and so on. Some items of business expenditure are not allowed for benefit purposes, so the income we use to work out your benefit may be different than that used by HM Revenue & Customs. If you want to know more about how we work out your income, please contact the Revenues & Benefits Service. Section 1 Your details Your full name Home address Home phone number address Section 2 Your business details Name of the business Business address Business phone number Type of business Date business started / / Start of current financial year / / Page 1

2 Section 2 Your business details continued Are you a director of the business? Yes No If Yes, please go to section 5. Is your business a partnership? Yes No If Yes, please list the partners and their percentage share of the business: Name % Name % Other than you, how many people work for the business? Section 3 Accounts Do you have any prepared accounts for the last financial year? Yes No If Yes, please return them with this form fully completed. If No, please give the reason why and the date you expect to have them If you have only just started trading please supply ESTIMATED accounts for your first three months of trading. You must provide final accounts as soon as they are available. Tick this box if the figures used are for a 3 month estimate for a new business OR Please give the exact period covered by the following accounts: From: To: (this must not include future dates) Income / Sales Plus Enterprise Allowance Plus closing stock Sub-total Less purchases Less opening stock Gross profit Average weekly hours worked: Page 2

3 Section 3 Accounts continued EXPENSES Include amounts that relate ONLY to the business Accountancy Advertising Bank charges (for business accounts only) Business insurance Business rates Cost of supplies Drawings Employees wages (not you or your partner) Heating and lighting for business Interest payments (for business loans only)* Petrol for business use only (or other fuel) Postage Protective clothing or uniforms Rent / mortgage for business premises Repairs for business Road Tax for business use only Stationery & Printing Telephone for business use Vehicle insurance for business use only Wages paid to your spouse Wages paid to yourself Other business expenses (please specify) Total expenses Gross profit Less total expenses Net profit Is it likely the trading figures for the current financial year will be similar to those shown above? Yes No If No, please explain why Page 3

4 Section 4 Business running at a loss If your business is running at a loss please answer the following questions:- Please specify how long that you predict that the business will run at a loss Please specify how you are meeting your day-to-day living expenses without any income from your business Have you applied for any other sources of income (ie: JobSeekers Allowance/Tax Credits,etc) for this period? Section 5 Business directors Are you/your partner a director of the company? Yes No Complete this section if you operate a registered Limited Company with you as the registered director. If No please go to section 6. How often do you partner get paid? every What are the average weekly hours worked? How much do you get paid before Tax, National Insurance and any pensions are taken off? How much do you get paid after Tax, National Insurance and any pensions are taken off? Page 4

5 Section 5 Business directors continued How are you paid? For example, in cash, by cheque or straight into a bank or building society account. If another person in your household is also a director please attach additional sheets to confirm their income details as above. Additional sheets attached? Yes No Please provide proof of your directors pay (last two monthly/four weekly slips or your last three fortnightly slips or your last five weekly slips) Please provide your most recent financial accounts. Section 6 Deductions National Insurance: Do you have an exemption certificate? Yes No Personal Pension Contributions: Do you contribute to a personal pension scheme? Yes No If Yes, how much do you pay? How often do you pay? every You must supply proof of payments made and membership of the scheme. For example, bank statements showing contributions made and a recent letter from the pension company. Section 7 Taxi Drivers If you are Taxi Driver please answer the following questions: Please state your current mileage Do you privately rent out your car(s)? Yes No If No; go to next question If Yes; how much do you receive per day/week? Do you hold a Hackney Carriage Licence? Yes No If No; go to section 8 If Yes; which Taxi firm do you work for? Please specify your weekly base fee Page 5

6 Section 8 Declaration WARNING It is an offence for anyone to make a statement or produce information that they know to be false, in order to obtain Housing Benefit or Council Tax Reduction. A person, if convicted, can be fined, sent to prison or both. DECLARATION I have filled in this form and declare that the information given within it is true and complete to the best of my knowledge. I will immediately tell the Council s Revenues & Benefits Service, in writing, if my income or circumstances change. I agree to the Council making any necessary enquiries to confirm the information given on this form. Signature: Date / / Name (in BLOCK CAPITALS): We will use the information you have given us to process your Housing Benefit and/or Council Tax Reduction claim/change of circumstances and to calculate your Council Tax liability. We will not give information about you to anyone else, or use information about you for other purposes, unless the law allows us to. Shepway District Council is the data controller for the purposes of the Data Protection Act If you want to know more about what information we have about you, or the way we use that information, you can ask. Returning this form: Please fill in and send this form to: Customer Contact, Shepway District Council, Castle Hill Avenue, Folkestone, Kent, CT20 2QY Telephone: (01303) Page 6

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