Housing Benefit and Council Tax Benefit. Self employed earnings information form Please read the notes at part E before completing this form

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1 FOR OFFICE USE ONLY Date of issue Claim reference number Please return this form to: The Benefits Team Tel: PO Box 152 Fax: Shute End Minicom: Typetalk Wokingham Berkshire Website: RG40 1WJ Housing Benefit and Council Tax Benefit Self employed earnings information form Please read the notes at part E before completing this form A. Questions about you and your business Your name Your address Daytime telephone number Date of Birth Postcode address Name of Business National Insurance number Type of Business Date business commenced Address of Business Start date of your financial year Average hours worked per week Postcode Please give details of what your business does. If you subcontract please include details below Is your business a partnership? No Yes What percentage do you own? % Page 1

2 If you are married, in a civil partnership or have a partner you live with do they have a share of the business? No Yes What percentage do they own? % (If the business is a partnership you should provide the partnership agreement) If you are married, in a civil partnership or have a partner you live No Yes with, do they work for the business? Do you use part of your home for running the business? No Yes Please give details in the box below Do you have separate business and personal vehicles? No Yes What percentage of the business vehicle is used for personal use? % What percentage of your personal vehicle is used for business use? % Do you have separate business and personal telephones? No Yes What percentage of your business telephone use is personal? % What percentage of your personal telephone use is business? % Do you use any building or land other than your home? No Yes Please give details in the box below Does your business have any other assets? No Yes Please give details in the box below Do you have any business bank accounts? No Yes What is the name of the account? Do you employ an accountant? No Yes If yes, what is their name? Do you have any audited accounts for the last financial year? No Yes Please provide the original set of accounts Page 2

3 B Income and expenditure statement Period covered From / / to / / This must be either your last financial year or if you have not been trading for a year, from the date your business started up to the current date. We must have your actual figures not estimates. You may be asked to provide evidence to support the level of income and expenditure declared. INCOME Sales, takings and income Tips Money from Princes Trust Business start-up allowance Cost of sales: Opening stock Plus stock purchased Less closing stock EXPENSES Total expense %personal use Drawings Wages paid out: To self To spouse/partner To others Travel costs: Vehicle insurance Vehicle tax Vehicle fuel Vehicle servicing and repairs Vehicle lease Other travel costs, for example train fares Rent or mortgage of business premises Business rates Water rates Gas and electricity Telephone Cleaning Business insurance: Public liability insurance Stock/contents insurance Property insurance Advertising Page 3

4 EXPENSES Total expense %personal use Subscriptions to professional bodies/trade organisations Business entertainment Printing and stationery Postage Bank charges on business accounts Accountants fees Small tools VAT paid less VAT received Interest payments on business loans Repair/replacement of business asset or machinery Was this covered by insurance? ( ) No Yes Leasing charges. Please state below what is leased. Bad debt provision (please give details below) Other expenses please give full details below (continue on a separate piece of paper if necessary, but remember to put your name and address on the sheet) YOU MAY NEED TO PROVIDE PROOF OF YOUR INCOME & EXPENDITURE Page 4

5 C. Questions for all claimants Do you expect your income and expenditure to be similar for the next 6 months? ( ) No If no, please explain the likely differences below (continue on a separate piece of paper if necessary, but remember to put your name and address on the sheet) Yes Do you pay into a personal pension scheme? ( ) No Yes (If yes, please provide original evidence of the amount you pay and a letter from the pension scheme provider confirming it is a private pension) D. Declaration You will use the information I have provided to process my claim for Housing Benefit, Council Tax Benefit or both. You may check some of the information with other sources as allowed by law. If I make an application for a Discretionary Housing Payment the council may also use the information on this form to help them make a decision on that application. You may use any information I have provided in connection with this and any other claim for Social Security benefits that I have made or may make. You may give some information to other organisations, or government departments, if the law allows this. I give you permission to check the information I have provided. You may also contact other organisations or people, where appropriate. I know that I must let the Benefits Team know about any changes in my circumstances or the circumstances of anyone who lives with me, which might affect my claim. I know that it is a criminal offence not to do so. I know that I must write to you within one calendar month of any change. I understand that if I knowingly give information that is incorrect or incomplete, I may be liable to prosecution or other action. I declare that the information I have given on this form is correct and complete. Your signature Date Wokingham Borough Council has a legal duty to protect the public funds it administers, and to this end may use the information you have provided on this form for the prevention and detection of fraud. As a result, information you provide on this form may be shared with other bodies responsible for auditing or administering public funds. Page 5

6 E. Notes to help you fill in the self employed earnings information form Filling in the form You must answer all the questions that apply to you on the form. If you need any help filling in the form please turn to page 7. Please use black ink to fill in the form and do not use pencil. If you make a mistake, just cross it out and put the right answer next to it. Do not use correction fluid or tape. Where there is a No or Yes box, please tick the relevant box. This form must be returned to us within 1 month of the date given on the front of this form. Part B Income and expenditure statement The period for which we need details of your income and expenditure will usually be your last financial trading year. If you have just started your self employment, you will be asked to estimate your income and expenditure for the first 3 months of trading. We will use this estimate to calculate your benefit entitlement and true figures will be requested after you have been trading for 3 months. If the true figures are substantially different to your estimate, then your Benefit may be recalculated from the start of your self employment and any overpayment will be recovered from you. If you have given us an estimate and during the first 3 months of trading you feel the estimate you have given us is incorrect, you should contact us straight away. When filling in the expenses section, you must state how much of an expense is personal use rather than business use. This will often be the case with travel and telephone costs. For example, if you have only one vehicle that you use for both business and personal use, you may consider that 70% of the costs are a business expense and 30% of the costs are a personal expense. In this example, you would put the full amount in the Total expense column and 30% in the final column. If you have a fixed place of work, then travel between your home and your place of work is classed as a personal expense. If you do not have a fixed place of work, then all travel connected with the business is an allowable expense. If you make payments on a business loan, we cannot treat payments to the principal as an expense unless the loan was taken out for the repair or replacement of an existing asset. Only interest payments are an allowable expense on any other business loan. Unlike HM Revenue and Customs, we do not allow depreciation of a business asset as an expense so there is no need to give details of any depreciation on this form. If you have completed part B because you have no accounts, or the accounts you have were not prepared by an accountant, we may need proof of your income and expenditure, such as invoices and receipts. Your business bank account statements may also be requested. Taxi drivers If you drive the owner s taxi and keep a % of the takings then you may be asked to provide: Taxi logs for each day worked and A summary of your daily takings and A letter from the owner confirming when you drove the taxi and how the takings were split. Page 6

7 Childminders If you are a childminder you may need to provide proof of your income but do not need to provide proof of your expenses. By law, the net income used for a childminder is one third of the gross income before expenses. Personal pension scheme If you make payments into a personal pension scheme you must provide original evidence of the amount you pay and a letter from the pension scheme provider confirming it is a private pension. When calculating your benefit, we will deduct half this amount from your income. When you have filled in this form, sign it and send it to us. What happens next? We will calculate your self employed income using the details you have given on this form. When we notify you of your entitlement to benefit we will enclose a sheet detailing: The period the self employed calculation covers Your gross income for that period Your allowable expenses for that period Your weekly net self employed income Notional tax and national insurance contribution figures Any private pension contribution Any adjustments we have made to the figures you have provided By law, we do not deduct the actual tax and national insurance contributions you pay. We calculate notional figures using our assessment of your net income and the same personal allowances and thresholds as used by HM Revenue and Customs. If you earn less than the small earnings exemption figure, no deduction will be made for national insurance contributions. We will review your self employed income periodically. You will then be required to complete one of these forms. Where to go for help and advice If you need help filling in the form or advice about any part of the form, you can contact the Council s Benefits Team in any of the following ways: By telephone on between 9.00am and 5.00pm Monday to Friday. By calling into the office at Wokingham Borough Council, Shute End, Wokingham between 9.00am and 5.00pm Monday to Friday. By at Customers with hearing difficulties can contact us via Typetalk on General information about Housing Benefit and Council Tax Benefit is available on the Council s website at If you need to write to us, the address is The Benefits Team, PO Box 152, Shute End, Wokingham, Berkshire RG40 1WJ. Page 7

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