Application for Council Tax Support or Housing Benefit (or both)

Save this PDF as:

Size: px
Start display at page:

Download "Application for Council Tax Support or Housing Benefit (or both)"

Transcription

1 Malvern Hills District Council 9973 Application for Council Tax Support or Housing Benefit (or both) Name For our use only Date you first contacted us Address Address and and Date you first contacted us postcode postcard Date of issue Date of issue Date received Date received Our reference Our reference What are you Council Tax Support Phone numbers (daytime)... (evening)... claiming What are for? you Housing Council Benefit Tax Support Phone numbers (daytime)... (evening)... do not have to give us your phone numbers, but it may help us if you do. claiming (Please tick) for? Second Housing Adult Benefit Rebate do not have to give us your phone numbers, but it may help us if you do. (Please tick) Important must read these notes before you fill in this form. If you do not understand any Second of the Adult notes Rebate on this application Important form, must please read contact these us. notes before you fill in this form. If you do not understand any of the notes on this Please application do not form, delay please in returning contact us. your form, as this can affect the day we can pay your Housing Benefit or Council Tax Support Please do from, not please delay in return returning as soon your as form, possible. as this can affect the day we can pay your Housing Benefit or Council Tax About Support Housing from, Benefit please return and Council as soon Tax as Support possible. Housing About Housing Benefit can Benefit pay all and or Council part of your Tax rent Support and Council Tax Support can pay all or part of your Council Tax. If you return this application Housing Benefit form within can pay one all month or part of of the your date rent you and first Council contacted Tax us Support (see the can date pay above), all or part we of will your treat Council that as Tax. the date If you you return made this your application. form within one month of the date you first contacted us (see the date above), we will treat that as the date you made your If application. you are married or in a civil partnership, or if you normally live with a partner, you and they must make a joint claim. If your partner works If you away, are married you must or in still a civil include partnership, them. If you or if have you normally capital or live savings with a of partner, more than you and 16,000 they you must may make nota be joint able claim. to claim If your Housing partner Benefit. works away, Please you contact must still us for include more them. advice. If you have capital or savings of more than 16,000 you may not be able to claim Housing 1Benefit. Information Please contact you give us us for more advice. 1 We will Information hold all of the you information give us you give to us on computer, so it is covered by the Data Protection Act Second We Adult will hold Rebate all of the information you give to us on computer, so it is covered by the Data Protection Act Second Second Adult Rebate Adult Rebate is Council (Claimant Tax Support must be for of people pensionable who may age) not have a partner but who share their home with someone who: Second is 18 or Adult over; Rebate is on is Council a low income; Tax Support and for does people not pay who them may not rent. have a partner but who share their home with someone If you who: are claiming is 18 or Second over; Adult is on a Rebate, low income; only fill and in sections does not 1, pay 2, 6, them 18, 19, rent. 20, 21 and 22 of this form. 3 Filling If in you this are form claiming Second Adult Rebate, only fill in sections 1, 2, 6, 18, 19, 20, 21 and 22 of this form. 3 Please Filling answer in this form question that applies to you. If a question does not apply to you, put a cross through it or write N/A. must read Please the answer notes on the question next page that about applies identification. to you. If a question must also does read not apply and sign to you, the put declaration a cross through (section it 22). or write N/A. If someone must read else the fills notes in this on form the for next you, page please about ask identification. them to fill in section must 20. also read and sign the declaration (section 22). 4 The proof If someone you need else to fills send in this with form your for form you, please ask them to fill in section When The you proof see this you symbol, need to we send need with proof your to confirm form the answers on your form. We need When to see you original see this documents, symbol, we not need photocopies. proof confirm the answers on your form. If you We don t need have to the see proof original we documents, need, send not us your photocopies. form now and then send the proof later. If you If do you not don t send have us the proof we need, it send will delay us your your form claim now and and you then will send lose the benefit. proof later. must If you provide do not send all proof us the within proof one we need, month it from will delay the date your you claim make and you this will claim. lose benefit. South Worcestershire must provide Revenues all proof & within Benefits one Shared month from Service the date you make this claim. Malvern Hills South District Worcestershire Council, Worcester Revenues City & Benefits Council and Shared Wychavon ServiceDistrict Council are now working together to improve services to customers. Malvern This Hills form District for use Council, by all Worcester customers City of these Council Councils. and Wychavon District Council are now working together to improve 5 If you services need help to customers. with this form This form is for use by all customers of these Councils. 5 Please If call you us need on help with this or form visit any of our local service centres below: Please call us on or visit any of our local service centres below: Malvern Hills District Council Malvern Hills District Council The Library, Graham Road, Malvern, WR14 2HU The Library, Graham Road, Malvern, WR14 2HU Upton Library, School Lane, Upton Upon Severn, Worcs, WR8 0LE Upton Library, School Lane, Upton Upon Severn, Worcs, WR8 0LE Tenbury Library, Teme Street, Tenbury Wells, Worcs, WR15 8AA Tenbury Library, Teme Street, Tenbury Wells, Worcs, WR15 8AA Worcester Worcester City Council City Council The Hive, The Sawmill Hive, Sawmill Walk, Walk, The Butts, The Butts, Worcester, Worcester, WR1 3PB WR1 3PB Wychavon Wychavon District District Council Council The Civic The Centre, Civic Centre, Queen Queen Elizabeth Elizabeth Drive, Drive, Pershore, Pershore, WR10 WR10 1PT 1PT Evesham Evesham Community Community Contact Contact Centre, Centre, Abbey Abbey Road, Road, Evesham, Evesham, WR11 WR11 4SB 4SB Droitwich Droitwich Spa Library, Spa Library, Victoria Victoria Square, Square, Droitwich Droitwich Spa, WR9 Spa, WR9 8DQ 8DQ 66 When When you have you filled have in filled this in application this application form form can take can take this this form form and and your your documents to to any of the offices shown above, or or please please post post your your form form Malvern, for Malvern, Worcester Worcester Wychavon or Wychavon to: South to: South Worcestershire Worcestershire Revenues Revenues and Benefits and Benefits Shared Shared Service Service Revenues Revenues and Benefits, and Benefits, PO Box PO 11, Box Pershore, 11, Pershore, WR10 1PU. WR10 1PU. To see how much Housing Benefit and Council Tax Support you you may may be be able able to to get, get, visit visit our our website at at

2 1 About you and your partner Please give details of you and your partner (if you have one). Title (Miss, Mr, Mrs, Ms, and so on) Last name First names Other names you have been known by Age Date of birth Daytime phone number Mobile number r address (If you give us your address we may contact you by .) National Insurance Number By partner we mean a person you are married to or have a civil partnership with, or a person you live with as if you were their husband, wife or civil partner. (A civil partnership is a formal arrangement that gives same-sex partners the same legal status as a married couple.) r partner Are you: single? Is your partner: a single parent? a single parent? married or in a civil partnership, living married or in a civil partnership, living together and not separated? together and not separated? living together? living together? divorced? divorced? separated? a widow, widower or surviving civil partner? a widow, widower or surviving civil partner? a care leaver? a care leaver? subject to a multi agency public protection? subject to a multi agency public protection? We cannot pay any Housing Benefit or Council Tax Support unless we have proof of your National Insurance number and identity. If we do not already have proof, we will contact you and ask to see an original, not a photocopy, of one of the following. Please provide one from the National Insurance list and one from the identity list below. 1 Proof of your National Insurance number r P45 r P60 A payslip A letter from the tax office A letter from the Department for Work and Pensions An RD3 National Insurance number card Proof of your identity Payslip Rent book, rent card or tenancy agreement Bank or building society statement or passbook Gas, electricity, fixed phone or water bill (utility bill) Driving licence (paper or photocard format) UK passport Medical card with NHS number Birth, adoption or marriage certificate Divorce, annulment or separation document Residence permit Other country passport or national ID card Immigration and Nationality Directorate (HO) travel document A letter from your solicitor to you Life assurance policy

3 2 About your home r address which you are claiming Housing Benefit or Council Tax Support for. Name Address and postcode Is this address your normal home address? r partner Is this: When did you move in? If you have not moved in yet, when do you plan to move in? must tell us when you have moved. Are you a joint homeowner or a joint tenant? a home you are buying? a home you own? a home you rent privately? a home you rent from a housing association or registered social landlord? a home you part-own under sharedownership or co-ownership scheme? someone else s home where you pay rent (for example, for lodgings)? someone else s home where you live as a friend or relative, or for other reasons? temporary accommodation (for example, bed and breakfast or a hostel)? Tell us the names of the other joint owners or tenants. a home you are buying? a home you own? a home you rent privately? a home you rent from a housing association or registered social landlord? a home you part-own under sharedownership or co-ownership scheme? someone else s home where you pay rent (for example, for lodgings)? someone else s home where you live as a friend or relative, or for other reasons? temporary accommodation (for example, bed and breakfast or a hostel)? Tell us the names of the other joint owners or tenants. Have you previously spent at least 3 months in a specialised hostel for homeless people? Have you lived at this address for less than two years? What was your previous address? What was your previous address? 2

4 2 About your home (continued) r partner Have you claimed Housing Benefit, Council Tax Benefit or Council Tax Support before? What type of property was your previous home? Owned by you Rented Other What name did you claim under? What address did you claim for? What type of property was their previous home? Owned by them Rented Other What name did they claim under? What address did they claim for? Are you living in a different place from the address you are claiming Housing Benefit or Council Tax Support for at the moment? (For example a hospital, a residential home or legal custody.) When was the last payment made? What is your address while you are away from your home? When was the last payment made? What is their address while they are away from their home? Why are you living at this address? Why are they living at this address? 3 Nationality Do you intend to return to your normal home? When did you start living at this address? When do you expect to return to your normal home? What nationality are you? Do they intend to return to their normal home? When did they start living at this address? When do they expect to return to their normal home? r partner What nationality are they? 3 Have you or your partner come to live in the UK, the Republic of Ireland, the Channel Islands or the Isle of Man in the last two years? Please go to section 4. Please go to section 4. Please give us details below. Please give us details below. We need to see your official papers as proof. We cannot accept photocopies. When did you arrive in the UK? When did they arrive in the UK? Are you seeking asylum in the UK? Are they seeking asylum in the UK?

5 3 Nationality (continued) 4 About your children Do you or your partner have any children living with you? A child is a person up to the age of 21 who lives with you and who you get Child Benefit for. Last name First names Have you been granted refugee status? Have you been granted exceptional leave to remain in the UK? Have you been granted temporary admission to the UK? Please go to section 5. Please give us details below. r partner Have they been granted refugee status? Have they been granted exceptional leave to remain in the UK? Have they been granted temporary admission to the UK? Child 1 Child 2 Child 3 Child 4 Age Date of birth Are they male or female? Are they registered blind? We need to see proof of registration. Do they receive Disability Living Allowance? If, we need to see your order book or award notice for each child. Child Benefit? If, we need to see your Child Benefit award notice for each child. When does the Child Benefit stop (if you know)? Do you have more than four children? 5 Student details Are you or your partner a full-time student? Please provide proof of income (for example, a student grant or loan). If, who does? If, who does? Please tell us about them in section 21. Please go to section 6. Please give us details below. We need to see proof of your course details or student registration details. This must be an original, not a photocopy. r partner Name of university or college Name of university or college Name of course Name of course Start and end date of course Start and end date of course 4

6 5 Student details (contined) Do you have a loan, grant or a bursary? If you do, please give details of the amount you receive per year. Does your grant include any of the following awards? If yes, please tell us the total amount you receive for these items? Loan Grant Bursary LOAN GRANT BURSARY Tuition Fee Loan Higher Education Grant Special Support Grant Disabled Students Allowance Parents Learning Alowance Childcare Grant r partner Loan Grant Bursary LOAN GRANT BURSARY Tuition Fee Loan Higher Education Grant Special Support Grant Disabled Students Allowance Parents Learning Alowance Childcare Grant 6 About other people who live with you Do any other people live with you? Please tell us about any other people who live with you, or who normally live with you but are away from home. Please go to section 6.1. Please give us details below. We need to see proof of income for the other people who live with you. Person 1 Person 2 Person 3 Person 4 Last name First names Date of birth Relationship to you or your partner National Insurance number What date did they move in? Do they normally live somewhere else? What is their normal address? Do they get Income Support or income-based Jobseeker s Allowance? We need to see proof of this. Do they get Disability Living Allowance, Personal Independence Payment or Attendance Allowance? We need to see proof of this. 5

7 6 About other people who live with you (continued) Do they work 16 hours or more each week? What gross wages are they paid each week (their wages before tax and any other deductions)? We need to see proof of this. Person 1 Person 2 Person 3 Person 4 What types of benefits do they receive (for example, tax credits or Pension Credit)? How much benefit are they paid each week? We need to see proof of this. How much interest were they paid from savings last year? We need to see proof of this. Are they a youth trainee? If, we need to see a letter or other document confirming that they are a youth trainee. Are they in full-time education? If, we need to see a letter or other document confirming that they are in full-time education. School, college or university Are they an apprentice? If, we need to see a letter or other document confirming that they are an apprentice. Are they a student nurse? If, we need to see a letter or other document confirming that they are a student nurse. Do they have a learning disability, mental illness or a form of dementia? Are they in hospital? If, what date did they go in? Are they in prison? If, what date were they detained? Are they working away? 6

8 6 About other people who live with you (continued) Are any of these people married to each other or civil partners, or living together as if they are married or civil partners? Please tell us who. Why are they living with you now? 6.1 People who have recently left your home Is anyone who was included on your last claim no longer living with you? Please go to section 7. Please give us details below. Person 1 Person 2 Name New address Date they left If you need any extra space, please give us the details in section About joint tenants, subtenants and boarders Do you let or sublet part of your home? A joint tenant is someone who shares your home but pays their rent to your landlord. A subtenant is a person who rents part of your home from you. A boarder is a person who rents part of your home and pays for meals that you provide. Last name First names Date of birth Relationship to you or your partner Weekly rent Please go to section 8. Please give us details below. Person 1 Person 2 Person 3 Person 4 Person 1 Person 2 Person 3 Person 4 Does the rent include heating? Does the rent include meals? 7

9 registration Do you use form. a vehicle Do for disabled you use a people vehicle or Do for a car disabled you rented use a people from vehicle or for a Motability? 8 car disabled Disability rented people from details or Please a Motability? car rented provide from your original Please agreement Motability? provide form. your original r partner Please agreement provide form. your original agreement Does Are you anyone registered form. receive Carer s Does blind? anyone Allowance receive to Does anyone receive What is the name of this person? What is the name of this person? Carer s look after Allowance you? Please provide your original to Carer s Allowance to What is the name of this person? What is the name of this person? look Please registration after provide form. you? proof of your What is the name of this person? What is the name of this person? look Please carer s after provide entitlement. you? proof of your Please carer s Do you provide entitlement. use a proof vehicle of your Do they live with you? Do they live with you? carer s for disabled entitlement. people or Do they live with you? Do they live with you? a car rented from Do they live with you? Do they live with you? Does your carer(s) Motability? Does provide your the carer(s) Do you have a spare bedroom that your carer(s) Do you have a spare bedroom that your carer(s) overnight? Does provide Please your provide the carer(s) your original Do uses you to have sleep a in spare overnight? bedroom that your carer(s) Do uses you to have sleep a in spare overnight? bedroom that your carer(s) provide agreement the form. overnight? care Do uses you to have sleep a in spare overnight? bedroom that your carer(s) Do uses you to have sleep a in spare overnight? bedroom that your carer(s) overnight? Does anyone receive uses to sleep in overnight? uses to sleep in overnight? Carer s Are you Allowance currently off to Are work you sick? currently off What is the name of this person? What is the name of this person? look after you? When did you last work? When did you last work? Are you currently off Please work sick? provide proof of your work sick? When did you last work? When did you last work? carer s entitlement. When did you / last work? / When did you / last work? / Do they live with you? Do they live with you? Are you in a hospital? Are will you need in a to hospital? tell us when Does Are you your in a carer(s) If hospital?, are you in a private hospital or If, are you in a private hospital or you return will need home. provide the to care tell us when receiving If Do, you have are private you a spare in treatment a private bedroom in hospital an that NHS your orhospital? carer(s) receiving If Do, you have are private you a spare in treatment a private bedroom in hospital an that NHS your orhospital? carer(s) you return will need home. to tell us when overnight? receiving If uses, to are sleep private you in in overnight? treatment a private in hospital an NHS orhospital? receiving If uses, to are sleep private you in in overnight? treatment a private in hospital an NHS orhospital? you return home. receiving private treatment in an NHS hospital? receiving private treatment in an NHS hospital? When did you go into hospital? When did you go into hospital? Are you currently off When did you go into hospital? When did you go into hospital? work sick? When did you / go into hospital? / When did you / go into hospital? / When did you last work? When did you last work? When do you expect to leave? When do you expect to leave? When do you expect to leave? When do you expect to leave? When do you / expect to / leave? When do you / expect to / leave? Are you in a hospital? 9 About your work will need to tell us when 9 About your work If, are you in a private hospital or If, are you in a private hospital or Are you return you About or home. your work receiving private Are treatment you or in your an NHS hospital? receiving Please private go treatment to section in an 10. NHS hospital? Are partner you a or director your of a Are partner you working? your Please go give to us section details 10. below. Are partner company? you a or director your of a Are partner you working? your Please go to section 10. Please give us details below. partner company? a director of a When partner did you go working? into hospital? When Please did give you us go details into hospital? below. company? 9.1 Work you do for an employer 9.1 Work you do for an employer 9.1 Work you do for an employer We need to see payslips as proof of any money you earn (we may contact your When do you expect to leave? When do you expect to leave? employer We need to for see confirmation). payslips as proof of any money you earn (we may contact your employer We The need number to for of see confirmation). payslips payslips / we need as / proof depends of any on how money often you you earn are paid. /(we may contact / your employer The Paid number for of week confirmation). payslips send we your need last depends five payslips on how often you are paid. 9 About your work The Paid number of week two payslips weeks send we send your need last your depends five last payslips three on how payslips often you are paid. Paid week two four weeks send your send last your five last payslips three two payslips Are you or your two three Paid Are four month you weeks send or your send your last two last payslips two payslips Please go to section 10. partner a director of a Paid If you do not four month have weeks any send partner working? payslips, send your your last please two last payslips two ask your payslips employer Please to give fill us in details the attached below. company? Paid If certificate you do not of month have earnings any send form payslips, your on last page please two 30. payslips ask your employer to fill in the attached certificate If you do not of have earnings any form payslips, on page please 30. ask your employer to fill in the attached certificate of earnings form on page 30. r partner 9.1 Work you do for an employer How many hours r partner Enter the number of hours Enter the number r of hours partner How do you many work? hours Enter you We work need the number each to see week. payslips as proof of any of hours Enter you money work you the number each earn week. (we may contact your of hours How many hours do you work? employer Enter you work the number each for week. confirmation). of hours Enter you work the number each week. of hours How do you many work? jobs you The work number each of week. payslips we need depends on how you often work each you are week. paid. How do you many have? jobs Paid week send your last five payslips do How you many have? jobs Paid two weeks send your last three payslips do you have? Paid four weeks send your last two payslips Paid month send your last two payslips If you do not have any payslips, please ask your employer to fill in the attached certificate of earnings form on page 30. r partner How many hours Enter the number of hours Enter the number of hours do you work? you work each week. you work each week. How many jobs do you have?

10 9.1 Work you do for an employer (continued) 9.1 Work you do for an employer (continued) If you have more than two jobs, please If Date you have you tell us more started about than your two work other jobs, please jobs tell us about your other for this and your employer other employers First job jobs in section and your 21. other employers First Employer s job in Is section your employment 21. for Employer s nameif, when is it due to end? a fixed period? Job title Employer s address Employer s address First job First job r partner r partner Employer s Employer s nameif, when is it due to end? Employer s address Employer s address Give the number of hours you work each week What is your employee Date number you or started payroll work Date for number? this you employer started work for this employer Is How your much employment are you paid? for Is a fixed your period? employment for a fixed period? How often are you paid? Job Job How title title are you paid? (Cheque, cash, direct into an account) Give the number of hours Give you work the number each week of hours Are you you work contracted each weekout of What the is National your employee Insurance What number is your or Scheme? payroll employee number? or payroll Have number? you had a pay rise during How much the last are you six paid? months? How much are you paid? How often are you paid? How often are you paid? Do How you are receive, you paid? or expect (Cheque, How are to cash, you receive direct paid? into any an bonuses (Cheque, account) cash, or profitrelated account) pay (or both)? Are you contracted out direct into an Do Are of the you you National receive, contracted or out expect of Insurance the National to receive Scheme? any overtime? Insurance Scheme? Have you had a pay rise Have you had a pay rise Do during during you the the receive, last six last six or expect months? months? to receive any tips?, or expect Do When you will to receive, receive you receive or any expect bonuses your next to or pay receive profitrelated (if you know)? pay or (or profit- both)? riseany bonuses related pay (or both)?, or 9 expect Do you to receive, receive or any expect overtime? to receive any overtime?, or expect Do you to receive, receive or any expect tips? to receive any tips? When will you receive When your next will pay you rise receive your (if next know)? pay rise (if you know)? If, when is it due to end? If, when is it due to end? If, please give the date of the pay rise If, how much? If, how much? If, please give the date If of, the pay please rise give the date If of, the pay how rise much? If, how much? If, how much? If, how much? If, how much? If, how much? If, how much? If, when is it due to end? If, when is it due to end? If, please give the date of the pay rise If, how much? If, how much? If, please give the date If of, the pay please rise give the date of If, the pay how rise much? If, how much? If, how much? If, how much? If, how much? If, how much? If, how much? 9 9

11 9.1 Work you do for an employer We need (continued) to see the last five payslips (if the employee is paid week), Please fill in the table below 9.1 Work for each you do job for you three payslips (if the employee is paid two weeks) or two payslips (if the Please fill in the table an employer We need (continued) to see the last five payslips (if the employee is paid week), or your partner have. employee is paid month or four weeks). below for each job you three payslips (if the employee is paid two weeks) or two payslips (if the Please fill in the table We need to see the last five payslips (if the employee is paid week), or your partner have. employee Employer is paid month or four weeks). Job Title below for each job you three payslips (if the employee is paid two weeks) or two payslips (if the or your partner have. employee Employer is paid month or four weeks). Job Title Employer 1 2 Job Title Date Date Tax code Date Tax code week number Tax Gross week code pay number to date Gross Hours Tax week pay worked number to date Hours Gross pay worked (before to date deductions) Gross Hours Working pay worked Tax (before Credit deductions) (from April 2003) Gross Working Sick pay pay Tax and (before Credit so on deductions) (from April 2003) Sick Working Deductions pay Tax and Credit so Taxon (from April 2003) Deductions Sick pay and so Tax National Insurance Deductions National Pension Tax scheme Insurance Pension Other National scheme Insurance Net pay (after Other Pension deductions) scheme Net pay (after Other deductions) If any holiday pay is Period from Period to included Net pay (after in the deductions) figures If any holiday pay is Period from Period to above, please give us included the figures Amount the If any following holiday details. pay is Period from Period to above, please give us the included following in the details. figures Amount above, please give us r partner Amount Employer Job Title the following details. r partner Employer Job Title Period to Period to Period to r partner Employer Job Title Date Tax Datecode Date Tax week code number Gross Tax code week pay number to date Hours Tax Gross week pay worked number to date Gross Hours pay worked (before to date deductions) Hours Gross Working pay worked Tax (before Credit deductions) (from April 2003) Gross Working Sick pay pay Tax and (before Credit so on deductions) (from April 2003) Deductions Working Sick pay Tax and Credit so Taxon (from April 2003) Deductions Sick pay and so National Tax Insurance Deductions Pension National Tax scheme Insurance Other Pension National scheme Insurance Net pay (after Other Pension deductions) scheme Net pay (after Other deductions) If any holiday pay is Period from included Net pay (after in the deductions) figures If any holiday pay is Period from above, please give us included the figures Amount the If any following holiday details. pay is Period from above, please give us the included following in the details. figures Amount above, please give us Amount the following details

12 9.1 Work you do for an employer (continued) Date you started work for this employer Is your employment for a fixed period? Job title Second job Employer s name If, when is it due to end? Employer s address r partner Second job Employer s name If, when is it due to end? Employer s address Give the number of hours you work each week What is your employee Date number you or started payroll work for number? this employer Is How your much employment are you paid? for a fixed period? How often are you paid? Job How title are you paid? (Cheque, cash, direct into an account) Give the number of hours you work each week Are you contracted out of What the is National your employee Insurance number or Scheme? payroll number? Have you had a pay rise during How much the last are you six paid? months? How often are you paid? Do How you are receive, you paid? or expect (Cheque, to cash, receive direct into any an bonuses account) or profitrelated pay (or both)? Are you contracted out Do of the you National receive, or expect Insurance to receive Scheme? any overtime? Have you had a pay rise Do during you the receive, last six or expect months? to receive any tips?, or expect When will to receive you receive any bonuses your next or pay profitrelated (if you know)? pay (or rise both)? If, when is it due to end? If, please give the date of the pay rise If, please give the date of the pay rise If, how much? If, how much? If, how much? If, how much? If, when is it due to end? If, please give the date of the pay rise If, please give the date of the pay rise If, how much? If, how much? If, how much? If, how much? 11, or expect to receive any overtime? If you have more than two jobs, please tell If us, about how much? them in section 21. If, how much?, or expect to receive any tips? When will you receive your next pay rise (if you know)? If, how much? If, how much? 11 If you have more than two jobs, please tell us about them in section 21.

13 9.1 Work you do for an employer We need (continued) to see the last five payslips (if the employee is paid week), Please fill in the table below 9.1 Work for each you do job for you three payslips (if the employee is paid two weeks) or two payslips (if the Please fill in the table an employer We need (continued) to see the last five payslips (if the employee is paid week), or your partner have. employee is paid month or four weeks). below for each job you three payslips (if the employee is paid two weeks) or two payslips (if the Please fill in the table We need to see the last five payslips (if the employee is paid week), or your partner have. employee Employer is paid month or four weeks). Job Title below for each job you three payslips (if the employee is paid two weeks) or two payslips (if the or your partner have. employee Employer is paid month or four weeks). Job Title Employer 1 2 Job Title Date Date Tax code Date Tax code week number Tax Gross code week pay number to date Tax Gross Hours week pay worked number to date Hours Gross pay worked to (before date deductions) Hours Gross Working pay worked Tax (before Credit deductions) (from April 2003) Gross Working Sick pay pay Tax and (before Credit so ondeductions) (from April 2003) Sick Working Deductions pay Tax and Credit so Taxon (from April 2003) Deductions Sick pay and so Tax National Insurance Deductions National Tax Pension scheme Insurance Pension National Other scheme Insurance Net pay (after Other Pension deductions) scheme Net pay (after Other deductions) If any holiday pay is Period from Period to included Net pay (after in the deductions) figures If any holiday pay is Period from Period to above, please give us included in the figures Amount the If any following holiday details. pay is Period from Period to above, please give us the included following in the details. figures Amount above, please give us Amount the r following partner details. Employer Job Title r partner Employer Job Title r partner Employer Job Title Date Tax Datecode Date Tax week code number Gross Tax code week pay number to date Tax Hours Gross week pay worked number to date Gross Hours pay worked to (before date deductions) Hours Gross Working pay worked Tax (before Credit deductions) (from April 2003) Gross Working Sick pay pay Tax and (before Credit so on deductions) (from April 2003) Deductions Working Sick pay Tax and Credit so Taxon (from April 2003) Deductions Sick pay and so National Tax Insurance Deductions Pension National Tax scheme Insurance Other Pension National scheme Insurance Net pay (after Other Pension deductions) scheme Net pay (after Other deductions) If any holiday pay is Period from included Net pay (after in the deductions) figures If any holiday pay is Period from above, please give us included in the figures Amount the If any following holiday details. pay is Period from above, please give us the included following in the details. figures Amount above, please give us Amount the following details Period to Period to If Period you have to more than two jobs, please tell us about them in section If you have more / than two jobs, / please tell us about them in section If you have more than two jobs, please tell us about them in section

14 9.2 Self-employed people r partner Are you or your partner self-employed? Please go to section 9.3. Please give us details below. Please go to section 9.3. Please give us details below. Are you or your partner sole traders or partners in the business? Sole trader Partner Please give details of the partnership and your share in the business. Sole trader Partner Please give details of the partnership and their share in the business. What does your business do? How many hours a week do you work? What is your weekly income from the business? Tax Reference Number When did you become self-employed? Please also note that you have 3 months from the date you became self employed in which to register with H.M. Revenues & Customs. must register as self employed regardless of your overall net profit / loss. H.M. Revenues & Customs will provide you with a Tax Reference Number which is required by this office if you are to be treated as self employed. We must see proof of any self-employed earnings, profit or loss before we can decide how much benefit you will get. This should be your most recent trading accounts or your summary of records of income and spending. If you cannot provide either of these, please contact us for a self-employed earnings form. We must see proof of any self-employed earnings, profit or loss before we can decide how much benefit they will get. This should be their most recent trading accounts or their summary of records of income and spending. If they cannot provide either of these, please contact us for a self-employed earnings form. 9.3 Other work r partner Do you or your partner get money from any work you How much? How much? have not told us about already? How often? How often? Do you or your partner do any voluntary work? 10 Money paid out 10.1 Money paid out for students Do you or your partner pay out towards the financial support of a student? Please go to section Please give us details below. We need to see their student award notice as proof of this. We cannot accept photocopies. How much do you pay? How often do you pay it? Every r partner How much do they pay? How often do they pay it? Every 13

15 10.2 Money paid towards childcare costs r partner Do you or your partner pay someone to look after any of your children? Please go to section Please go to section Please give us details below. Please give us details below. We may need to send you another form about this. Please tell us the names of the children. Please tell us the names of the children. If you have a childminder, please enclose proof of their registration and agreement. Who provides the care? A registered childminder A school on school premises A local authority Other (please give details below) Who provides the care? A registered childminder A school on school premises A local authority Other (please give details below) What is the name of the carer? What is the name of the carer? What is their registration number? What is their registration number? What is the address of the carer? What is the address of the carer? Please provide evidence of the amount you pay. Does it change during the year? What is the normal weekly cost of the childcare? Does your education authority pay towards your childcare? If yes, please give further details in Section 21. What is the normal weekly cost of the childcare? Does their education authority pay towards your childcare? If yes, please give further details in Section Money paid towards a pension plan r partner Do you or your partner pay money into a pension plan that is not paid through your employer? Please go to section 11. Please give us details below. Please go to section 11. Please give us details below. We need to see proof of this. This must be a policy document and another document showing the payments made. We cannot accept photocopies. How much? How often? Every How much? How often? Every 14

16 11 About your benefits and pensions 11 About your benefits and pensions 11 About your benefits and pensions Do you or your partner Do you or claim your any benefits partner claim or pensions? any benefits or pensions? Please go to section 12. Please Do tell go you to us section about or your them 12. below. Please go to section 12. Please partner tell us about claim them any below. Please tell us about them below. benefits or pensions? We need to see proof of any benefits or pensions you have. The We need proof to should see proof be an of original, any benefits not a or photocopy, pensions We you of need an have. award to see notice proof of showing any benefits the current or pensions y rates. The proof should be an original, not a photocopy, The of proof an award should notice be an showing original, the not current a photocopy, o rates. rates Benefits r partner 11.1 Benefits 11.1 Benefits r partner Child Do you Benefit? receive 62 Do you receive 62 Child Benefit? Child Benefit? Child Do you Tax receive Credit? We Child need Tax to Credit? see your award We need letter. to see your award letter. Attendance Allowance? Attendance Allowance? Child Tax Credit? We need to see your award letter. Attendance Allowance? Severe Do you Disablement receive Severe Allowance? Disablement Allowance? Severe Disablement Allowance? Carer s Allowance? Carer s Allowance? Do you 62 receive Carer s Allowance? Who is it paid for? Who is it paid for? Who is it paid for? Who is it paid for? Who Disability Living Allowance Disability Living or Personal Indepedence Allowance or Payment Personal (care Indepedence component)? Payment (care component)? Disability Living Allowance Disability Living or Personal Independence Allowance or Personal Payment Independence (mobility component)? Payment Do (mobility you component)? receive Income Support or the Income Guarantee Support or part the of Pension Guarantee Credit? part of Do Pension you receive Credit? income-based Jobseeker s income-based Allowance? Jobseeker s Allowance? Working Tax Credit? We Working need to Tax see Credit? your award We need letter. to see your award letter Disability Living 62 Allowance or Personal Indepedence Payment (care component)? 62 Disability Living 62 Allowance or Personal Independence Payment (mobility component)? Please answer the question below. Please Do go answer you to section receive the question 14. Income below. Please Support go to section or the 14. Guarantee part of Please Pension go to section Credit? Please Do go you to section receive income-based Please go to section 14. Jobseeker s Allowance? Do you 62 receive Working Tax Credit? We need to see your award letter. Please answer the question below. Please go answer to section the question 14. below. Please go to section 14. Please go to section Please go to section Please go to section 14. Ho 15 15

17 11.2 Other benefits contribution-based Jobseeker s Allowance? a Widowed Parent s Allowance? Disability Living Allowance for a child? Employment Support Allowance. Do you receive Income Related (IR)? r partner or Contribution (C) If, are you in the assessment phase or are you in the main phase? Incapacity Benefit? Statutory Sick Pay? Statutory Maternity Pay or Statutory Paternity Pay? a Maternity Allowance? Industrial Injuries Benefits? a Training Allowance? a th Training Allowance? 16

18 11.2 Other benefits (continued) Are there any other benefits you receive which are not listed on the previous pages? r partner Name of the benefit Name of the benefit Name of the benefit Name of the benefit 11.3 Pensions r partner the Savings part of Pension Credit? a State Retirement Pension? Have you or your partner put off receiving your State Pension? Have you received a lump sum from a pension you have delayed receiving? a Widow s Pension? If you know the date when your pension or pensions increase each year, please tell us in section 21 (Additional information). a War Disablement Pension, a War Widow s Pension or an Armed Forces and Reserve Forces Compensation Scheme payment? an Armed Forces pension? a pension from Capita (the Paymaster General)? We need to see your payment advice slip. a works pension from a former employer? We need to see your payment advice slip. any other pension? We need to see your payment advice slip. Have you or your partner put off drawing all or part of a personal pension? If, we will need to see proof of this arrangement. 17

19 12 r other income Do you or your partner have any other money coming in? Please go to section Please give us details below. We need to see proof of any other income you have. This must be an original, not a photocopy of, for example: an award notice showing the income being paid; a letter from the person who pays the income (where possible this must be on headed paper); a letter from an absent parent or ex-partner confirming maintenance payments; or a notice from the Child Support Agency Money coming in r partner any maintenance payments? If yes, please tell us who this maintenance is for If yes, please tell us who this maintenance is for How much do you get? How much do you get? Who pays this money? Who pays this money? money from a trust fund? How much do you get? How much do they get? any money for fostering or adopting a child? How much do you get? How much do they get? any money from a charity or voluntary organisation? How much do you get? How much do they get? financial support as a student? How much do you get? How much do they get? any income or rent from tenants? How much do you get? How much do they get? any money from someone else? Who pays this money? Who pays this money? How much do you get? How much do they get? 12.2 Money expected r partner Have you or your partner applied for any income that you have not received? What is it? What is it? Who from? Who from? How much do you expect to get? How much do they expect to get? 18

20 13 About your savings 13.1 Current accounts We need to know about all the money you and your partner have in any sort of account with a bank or building society or any other organisation. This includes current accounts, deposit accounts, ISAs, TESSAs and PEPs. We need to see proof of any accounts you have. All savings books and so on must be up to date, showing all interest due. This must be an original, not a photocopy of, for example: a bank or building society statement for the last three months showing debits (money going out), credits (money coming in) and the balance; a letter from a bank or building society showing the type of account, account number, the balance and regular deposits for the last three months; or statements for certificates, bonds, unit trusts, stocks and shares. If there is not enough room for details of all your accounts, please give details in section 21. Do you or your partner have any current accounts? A current account is an account you use regularly. It will probably accept direct debits and have a chequebook. We will need to see two months statements for each account. Please go to section Please give us details below. If you need more space, fill in your details in section 21. r partner Name of organisation Name of organisation Name of account Name of account Account number Amount in account Account number Amount in account Name of organisation Name of organisation Name of account Name of account Account number Amount in account Account number Amount in account 13.2 Savings, capital and investments Do you or your partner have any savings, capital or investments? Remember to include accounts at: high-street banks; supermarket banks; internet banks; building societies; and post offices. Please go to section Please give us details below. If you need more space, fill in your details in section 21. r partner Name of organisation Name of organisation Name of account Name of account We will need to see two months statements for each account. Account number Amount in account Account number Amount in account Name of organisation Name of organisation Name of account Name of account Account number Amount in account Account number Amount in account 19

21 13.2 Savings, capital and investments (continued) Remember to include accounts at: high-street banks; supermarket banks; internet banks; building societies; post offices; and credit unions We will need to see two months statements for each account. Name of organisation Name of account Account number Amount in account r partner Name of organisation Name of account Account number Amount in account Name of organisation Name of organisation Name of account Name of account Account number Amount in account Account number Amount in account Do any of your savings or bank accounts include a lump-sum payment received as a result of putting off receiving your or your partner s State Pension? We must see proof of this. Name of account Amount of lump sum Date paid in Name of account Amount of lump sum Date paid in Have you or your partner received a Far Eastern Prisoner of War Payment? 13.3 National Savings Certificates and Premium Bonds Do you or your partner have any National Savings Certificates or Premium Bonds? Please go to section Please give us details below. If you need more space, fill in your details in section 21. r partner National Savings Certificates Issue number Date bought Value National Savings Certificates Issue number Date bought Value Premium Bonds How many do you have? What are they worth? Premium Bonds How many do they have? What are they worth? 20

Housing Benefit and Council Tax Support claim form www.merton.gov.uk/benefits

Housing Benefit and Council Tax Support claim form www.merton.gov.uk/benefits Housing Benefit and Council Tax Support claim form www.merton.gov.uk/benefits Filling in the form Answer or questions by putting a tick in the relevant box. Do not put a cross or miss out any questions

More information

Claim form for Housing Benefit and Council Tax Reduction

Claim form for Housing Benefit and Council Tax Reduction Claim form for Housing Benefit and Council Tax Reduction If you are just claiming Second Adult Rebate, only fill in Parts 1, 3 and 15 of this form and tick this box. Part 1 About you and your partner Do

More information

A claim form for Housing Benefit and Council Tax Benefit

A claim form for Housing Benefit and Council Tax Benefit Town Hall Darlington DL1 5QT Phone: 01325 388514 Fax: 01325 388374 E-mail: HBEnquiries@darlington.gov.uk For office use only Housing Benefit reference number Date form requested Return by Issued by UPRN

More information

Housing Benefit and Council Tax Reduction claim form

Housing Benefit and Council Tax Reduction claim form Revenues & Benefits Service Community Contact Centre Town Hall, Queens Square Hastings TN34 1TL Tel: 01424 451080 Fax: 01424 451541 benefits@hastings.gov.uk www.hastings.gov.uk FOR OFFICE USE ONLY Date

More information

Herefordshire Council Claim form for Housing Benefit, Council Tax Reduction and free school meals

Herefordshire Council Claim form for Housing Benefit, Council Tax Reduction and free school meals Herefordshire Council Claim form for Housing Benefit, Council Tax Reduction and free school meals Crystal Mark 9252 Do not write in this box it is for office use only. Date form sent out: Form to be returned

More information

H o u s i n g B e n e f i t a n d C o uncil Ta x R e d u c t i o n a p p l i c a t i o n form

H o u s i n g B e n e f i t a n d C o uncil Ta x R e d u c t i o n a p p l i c a t i o n form HB&CTB-20ppForm-11Dec09-PM:Layout 1 11/12/2009 16:49 Page 1 H o u s i n g B e n e f i t a n d C o uncil Ta x R e d u c t i o n a p p l i c a t i o n form Section 1 Please use a black pen to fill in this

More information

Application for Housing Benefit or Council Tax Support (or both)

Application for Housing Benefit or Council Tax Support (or both) Application for Housing Benefit or Council Tax Support (or both) Director or Finance and Corporate Services, Civic Centre, Neath SA11 3QZ For benefit enquiries relating to the Neath Borough and Upper Lliw

More information

Please tell us your full name and address. Your title (Mr, Mrs, Miss and so on) Your last name. Your first names. Your address and postcode

Please tell us your full name and address. Your title (Mr, Mrs, Miss and so on) Your last name. Your first names. Your address and postcode Please tell us your full name and address. r title (Mr, Mrs, Miss and so on) r last name A claim form for Housing Benefit and Council Tax Benefit Ashfield District Council, PO Box 5752, Kirkby in Ashfield,

More information

Housing Benefit and Council Tax Reduction Scheme Claim Form

Housing Benefit and Council Tax Reduction Scheme Claim Form Housing Benefit and Council Tax Reduction Scheme Claim Form District Council Title (Mr, Mrs, Miss, Ms) Surname/Family Name First Names Address Benefit Reference (if claimed at South Oxfordshire or Vale

More information

Application for Rent (Housing Benefit) & Council Tax Benefit

Application for Rent (Housing Benefit) & Council Tax Benefit Sedgemoor District Council Application for Rent (Housing Benefit) & Council Tax Benefit Please complete and return this form to: The Benefits Service, Bridgwater House, King Square, Bridgwater, Somerset

More information

Housing Benefit and Council Tax Support claim form for private tenants

Housing Benefit and Council Tax Support claim form for private tenants Name: Address: Postcode: Revenues and Benefits Council Offices South Street Rochford Essex SS4 1BW Phone: 01702 318197 or 01702 318198 Email: revenues&benefits@rochford.gov.uk Housing Benefit and Council

More information

HELP WITH RATES HOUSING BENEFIT AND RATE RELIEF CLAIM FORM FOR OWNER OCCUPIERS

HELP WITH RATES HOUSING BENEFIT AND RATE RELIEF CLAIM FORM FOR OWNER OCCUPIERS Date requested Date issued Ratepayer ID Occupancy ID THIS BOX FOR OFFICIAL USE (Find these details on your rate bill) START THE FORM HERE Claim number r name and address FOR OFFICIAL USE HELP WITH RATES

More information

Housing Benefit and Council Tax Reduction claim form

Housing Benefit and Council Tax Reduction claim form Lewes District Council Southover House, Southover Road Lewes BN7 1AB Opening Hours: Mon Fri 9:00 5:00 Direct Telephone: 01273 484186 Switchboard: 01273 471600 Email: benefit@lewes.gov.uk Minicom (01273)

More information

How to fill in this form

How to fill in this form Claim form for Housing Benefit and application for Council Tax Reduction Name and address of the person claiming or applying: Reference number: For office use only Issue date: Date received: Revenues and

More information

Housing benefit and council tax support claim form

Housing benefit and council tax support claim form Housing benefit and council tax support claim form Name: Address (for which you wish to claim): Reference: Date issued: Date received: (office use only) Form issued by: Please return this form as soon

More information

Housing Benefit & Council Benefit Claim Form

Housing Benefit & Council Benefit Claim Form 2012/13 Please use capital letters Name Address Housing Benefit & Council Benefit Claim Form Don t delay - claim today! Do not delay returning this form if you do not have all the information that is asked

More information

A claim form for Housing Benefit and Council Tax Support Any delay in returning this form could mean you lose benefit

A claim form for Housing Benefit and Council Tax Support Any delay in returning this form could mean you lose benefit Date of first contact Date of issue Applicants name Issuing officers signature Claim reference number FOR OFFICE USE ONLY Please return this form to: Benefits Team PO Box 4 Lancaster LA1 1QR Tel: (01524)

More information

HOUSING BENEFIT, COUNCIL TAX BENEFIT AND SECOND ADULT REBATE CLAIM FORM

HOUSING BENEFIT, COUNCIL TAX BENEFIT AND SECOND ADULT REBATE CLAIM FORM For Office Use Only Ben Ref o: Date of Issue: Reason for Issue: Receipt Stamp HOUSIG BEEFIT, COUCIL TAX BEEFIT AD SECOD ADULT REBATE CLAIM FORM ou should complete and return this form as soon as you can.

More information

HOUSING BENEFIT, COUNCIL TAX BENEFIT AND SECOND ADULT REBATE CLAIM FORM

HOUSING BENEFIT, COUNCIL TAX BENEFIT AND SECOND ADULT REBATE CLAIM FORM For Office Use Only Ben Ref o: Date of Issue: Reason for Issue: Receipt Stamp HOUSIG BEEFIT, COUCIL TAX BEEFIT AD SECOD ADULT REBATE CLAIM FORM ou should complete and return this form as soon as you can.

More information

Application Form. Date received: Please read tear-off 3 help notes at the back of this form BEFORE you complete it.

Application Form. Date received: Please read tear-off 3 help notes at the back of this form BEFORE you complete it. Application Form Housing Benefit Council Tax Reduction Alternative Council Tax Reduction This form can be made available in other languages and formats (including large print, audio tape and Braille as

More information

Help with your Rent and Council Tax

Help with your Rent and Council Tax Help with your Rent and Council Tax Please tear off pages 1 to 4 for your reference Important information if you or your partner are awarded Universal Credit from the DWP If you or your partner are awarded

More information

Housing Benefit claim form

Housing Benefit claim form Housing Benefit claim form Application form for the Local Council Tax Reduction Scheme Filling in the form If you are just claiming Second Adult Reduction, only fill in Parts 1, 3, 16, 17 and 18 of this

More information

Housing Benefit and Local Council Tax Support claim form

Housing Benefit and Local Council Tax Support claim form 2013/14 Housing Benefit and Local Council Tax Support claim form Don t delay - claim today! Please return this form as quickly as possible, even if you do not have everything we ask for. can send the rest

More information

A claim form for housing benefit and council tax benefit

A claim form for housing benefit and council tax benefit A claim form for housing benefit and council tax benefit Isle of Wight Council Offices, Broadway, Sandown, PO36 9EA Tel: (01983) 823950 Name, address and postcode For official use only Hb ref: Date received

More information

A Claim Form for Housing Benefit and Council Tax Reduction

A Claim Form for Housing Benefit and Council Tax Reduction Issue Date: Benefit Reference No: Property Reference No: A Claim Form for Housing Benefit and Council Tax Reduction East Lothian Council, Support Services, PO Box 13261, Haddington, East Lothian, EH41

More information

Housing benefit and council tax benefit claim form

Housing benefit and council tax benefit claim form Housing benefit and council tax benefit claim form It is important that you send your completed form now. You can send any information you have not included later, but we must receive it within one month

More information

Housing Benefit and Council Tax

Housing Benefit and Council Tax HCTB1 notes 05/06 Housing Benefit and Council Tax Benefit tes for filling in the claim form for Housing Benefit and Council Tax Benefit About this form About Housing Benefit and Council Tax Benefit Second

More information

Housing Benefit and Council Tax Support Claim form

Housing Benefit and Council Tax Support Claim form Claim_rev 39 17/9/09 22:22 Page 1 Housing Benefit and Council Tax Support Claim form Do not write in this box. It is for office use only. Date of issue: Version: Sept 2009 Office receipt date stamp Please

More information

East Riding of Yorkshire Council Council Tax Support Scheme A summary of the scheme for Pension Age and Working Age persons 2016/2017

East Riding of Yorkshire Council Council Tax Support Scheme A summary of the scheme for Pension Age and Working Age persons 2016/2017 East Riding of Yorkshire Council Council Tax Support Scheme A summary of the scheme for Pension Age and Working Age persons 2016/2017 1 Introduction... 3 The council tax support scheme for Pensioners (persons

More information

Thank you for downloading this Housing Benefit and Council Tax benefit claim form.

Thank you for downloading this Housing Benefit and Council Tax benefit claim form. Cambridge City Council Revenue Services (Benefits) FREEPOST PO Box 130 Cambridge CB2 1BR Tel (01223) 457721/86, 457693/97 Email: benefits@cambridge.gov.uk Website: www.cambridge.gov.uk Thank you for downloading

More information

Claim for Housing Benefit and Application for Council Tax Support

Claim for Housing Benefit and Application for Council Tax Support Claim for Housing Benefit and Application for Council Tax Support (Help with your rent and Council Tax) Please complete this form in BLACK ink, and place a TICK (a) in the relevant boxes. Please read the

More information

HOUSING BENEFIT AND COUNCIL TAX REDUCTION APPLICATION

HOUSING BENEFIT AND COUNCIL TAX REDUCTION APPLICATION str1887 SLP1463 Renfrew Booklet_str1887 SLP1463 Renfrew Booklet 18/02/2013 15:28 Page 1 HOUSING BENEFIT AND COUNCIL TAX REDUCTION APPLICATION PLEASE COMPLETE USING INK AND CAPITAL LETTERS Name Address

More information

A claim form for Housing Benefit and Council Tax Benefit. Notes for filling in the Housing Benefit and Council Tax Benefit claim form

A claim form for Housing Benefit and Council Tax Benefit. Notes for filling in the Housing Benefit and Council Tax Benefit claim form Benefits Section rthumberland County Council Wansbeck Square Ashington rthumberland NE63 9XL Tel: 0345 600 6400 Name:................................................. Address:........................................................................................................................................................................................Post

More information

CLAIM FOR HOUSING BENEFIT COUNCIL TAX REDUCTION

CLAIM FOR HOUSING BENEFIT COUNCIL TAX REDUCTION Finance and Customer Services Revenues and Benefits CLAIM FOR HOUSING BENEFIT COUNCIL TAX REDUCTION Name Address Postcode Home Number Mobile Number Email Address Issuing Office Date Issued Reason Issued

More information

Claim form for Council Tax Support Benefit and Housing Benefit

Claim form for Council Tax Support Benefit and Housing Benefit Benefits Service Benefits Service PO Box 1, Town Hall, Ripley PO Derbyshire, Box 1, Town East Hall, Midlands, RipleyDE5 3BT Derbyshire, Phone: 01773 East 841470 Midlands, DE5 3BT Phone: Fax: 01773 01773

More information

Claim form for Housing Benefit and Council Tax Benefit

Claim form for Housing Benefit and Council Tax Benefit office use only Claim form for Housing Benefit and Council Tax Benefit To make a claim online visit our website: www.newcastle.gov.uk/benefits Name: Address: Date issued Date stamp Claim reference (if

More information

A claim form for Housing Benefit and Council Tax Support

A claim form for Housing Benefit and Council Tax Support Benefits Section Pippbrook Dorking Surrey RH4 1SJ Tel: 01306 879187 Fax: 01306 879395 Email: benefits@molevalley.gov.uk Name: Address: OFFICIAL USE ONLY Ben Ref: Date requested: Date issued: Claim type:

More information

Housing Benefit & Council Tax Reduction 2015-2016 Benefits Ref:

Housing Benefit & Council Tax Reduction 2015-2016 Benefits Ref: Housing Benefit & Council Tax Reduction 2015-2016 Benefits Ref: Housing Benefit and Council Tax Reductions are normally granted from the Monday following the day you apply so do not delay in making an

More information

Getting your deferment application form right. Use these notes to help you complete your student loan deferment application form

Getting your deferment application form right. Use these notes to help you complete your student loan deferment application form Getting your deferment application form right Use these notes to help you complete your student loan deferment application form If you need any help, please go to www.erudiostudentloans.co.uk or call us

More information

Application Form For: Housing Benefit, Council Tax Benefit or Council Tax Reduction Scheme, Second Adult Rebate and Free School Meals

Application Form For: Housing Benefit, Council Tax Benefit or Council Tax Reduction Scheme, Second Adult Rebate and Free School Meals Application Form For: Housing Benefit, Council Tax Benefit or Council Tax Reduction Scheme, Second Adult Rebate and Free School Meals This form can be returned in person to any of the addresses below:

More information

Council Tax Support and Housing Benefit Claim Form Don t delay - claim today!

Council Tax Support and Housing Benefit Claim Form Don t delay - claim today! 2014/15 Council Tax Support and Housing Benefit Claim Form Don t delay - claim today! Please return this form as quickly as possible, even if you do not have everything we ask for, to make sure that you

More information

A claim form for Housing Benefit and Council Tax Support

A claim form for Housing Benefit and Council Tax Support A claim form for Housing Benefit and Council Tax Support Date of contact Benefits Ref Council Tax Ref Property Ref DATE STAMP PART 1 About you and your partner Do you have a partner who normally lives

More information

Claim for Council Tax Support and Housing Benefit

Claim for Council Tax Support and Housing Benefit Claim for Council Tax Support and Housing Benefit Do not fill out this form until you have read these notes. After you have read and understood them, remove the notes by tearing along the perforated line.

More information

Please take the time to read these notes on the front and back of this page before you fill in this form.

Please take the time to read these notes on the front and back of this page before you fill in this form. Phone: 01656 643643 Minicom: 01656 643671 E-mail: benefits@bridgend.gov.uk Bridgend County Borough Council PO Box 107 Bridgend CF31 1WB Name: Address: Reference number: Date issued: Date of first contact:

More information

Housing Benefit & Council Tax Support - NEW CLAIM and Free School Meals

Housing Benefit & Council Tax Support - NEW CLAIM and Free School Meals If you need any help please ring: ( 0845 070 1066 Charged at local rate Name and address Date Issued Ref Housing Benefit & Council Tax Support - NEW CLAIM and Free School Meals Use this form to claim Housing

More information

A claim form for: Housing Benefit An application for: Council Tax Reduction Scheme Second Adult Rebate

A claim form for: Housing Benefit An application for: Council Tax Reduction Scheme Second Adult Rebate A claim form for: Housing Benefit An application for: Council Tax Reduction Scheme Second Adult Rebate Name: Address you are claiming or applying for: Address and postcode: Please read the guidance notes

More information

Sheffield Benefits Service

Sheffield Benefits Service Sheffield Benefits Service April 2013 Housing Benefit & Council Tax Support for people of working age Housing Benefit and Council Tax Support Housing Benefit is a national welfare benefit, administered

More information

Universal Credit. In this factsheet you can find out what benefits are being replaced by UC, who can get it and how much you could get.

Universal Credit. In this factsheet you can find out what benefits are being replaced by UC, who can get it and how much you could get. Universal Credit Universal Credit (UC) is a new benefit for people of working age. You can get it if you have a low income or do not work. Some people started getting it in April 2013. In this factsheet

More information

A claim form for Housing Benefit and Council Tax Benefit

A claim form for Housing Benefit and Council Tax Benefit Benefits Section Town Hall The Parade EPSOM Surrey KT18 5BY Tel: 01372 732269 Name: Address: OFFICIAL USE ONLY Ben Ref: Date requested: Date issued: Claim type: A claim form for Housing Benefit and Council

More information

A claim form for Housing Benefit and Local Support for Council Tax

A claim form for Housing Benefit and Local Support for Council Tax SCARBOROUGH BOROUGH COUNCIL BENEFITS SERVICE - Striving for Excellence A claim form for Housing Benefit and Local Support for Council Tax NOTE: You must provide all relevant proofs within one calendar

More information

Glasgow City Council. Housing Benefit and Council Tax Reduction Application Information

Glasgow City Council. Housing Benefit and Council Tax Reduction Application Information Glasgow City Council Housing Benefit and Council Tax Reduction Application Information Section 1 Personal Details To help us process your application and allow us to contact you if we need more information,

More information

Housing Benefit & Council Tax Reduction Claim Form

Housing Benefit & Council Tax Reduction Claim Form Wokingham Borough Council Benefits Service, P.O.Box 152, Shute End, Wokingham, Berks, RG40 1WJ Main switchboard Tel: 0118 974 6000 or Benefits Service Tel: 0118 974 6625 or 0118 974 6711 Minicom: 0118

More information

HOUSING BENEFIT AND COUNCIL TAX SUPPORT 2015-16. www.havering.gov.uk

HOUSING BENEFIT AND COUNCIL TAX SUPPORT 2015-16. www.havering.gov.uk HOUSING BENEFIT AND COUNCIL TAX SUPPORT 2015-16 www.havering.gov.uk What are Council Tax Support and Housing Benefit? Council Tax Support helps people pay their Council Tax. The Government decided to replace

More information

APPLICATION FOR HOUSING BENEFIT, LOCAL HOUSING ALLOWANCE AND COUNCIL TAX REDUCTION

APPLICATION FOR HOUSING BENEFIT, LOCAL HOUSING ALLOWANCE AND COUNCIL TAX REDUCTION APPLICATION FOR HOUSING BENEFIT, LOCAL HOUSING ALLOWANCE AND COUNCIL TAX REDUCTION Please note this form is also available in Welsh Housing Benefits Ty Elwyn, Llanelli, SA15 3AP. Tel: (01554) 742100 E-mail:

More information

APPLICATION FORM FOR HOUSING BENEFIT AND/OR COUNCIL TAX SUPPORT

APPLICATION FORM FOR HOUSING BENEFIT AND/OR COUNCIL TAX SUPPORT ISSUE CLAIM REF. DATE: TYPE: NO: APPLICATION FORM FOR HOUSING BENEFIT AND/OR COUNCIL TAX SUPPORT Before completing this application please ensure that you read the notes. In addition to this the evidence

More information

Housing Benefit and Council Tax Support (reduction) Claim Form

Housing Benefit and Council Tax Support (reduction) Claim Form Housing Benefit and Council Tax Support (reduction) Claim Form Don t delay - claim today! Please return this form as quickly as possible, even if you do not have everything we ask for. You can send the

More information

Local Council Tax Support and Housing Benefit Claim Form Don t delay - claim today!

Local Council Tax Support and Housing Benefit Claim Form Don t delay - claim today! 2014/15 Local Council Tax Support and Housing Benefit Claim Form Don t delay - claim today! Please return this form as quickly as possible, even if do not have everything we ask for. can send rest to us

More information

SSDC Draft LSCT Scheme v 1.10 1

SSDC Draft LSCT Scheme v 1.10 1 South Staffordshire District Council Council Tax Support A summary of the scheme for Pension Credit Age persons and the draft scheme for Working Age persons SSDC Draft LSCT Scheme v 1.10 1 South Staffordshire

More information

Housing Benefit claim form

Housing Benefit claim form Housing Benefit claim form Application form for the Local Council Tax Reduction Scheme Filling in the form If you are just claiming Second Adult Reduction, only fill in Parts 1, 3, 17, 16, 18 17 and 19

More information

Application form for Housing Benefit and/or Council Tax Reduction

Application form for Housing Benefit and/or Council Tax Reduction For Office Use Only Date of issue First point of contact Ref Name and address of applicant (including room or flat number) Name: Address: : Application form for Housing Benefit and/or Council Tax Reduction

More information

Reading Borough Council

Reading Borough Council Reading Borough Council Council Tax Reduction Scheme for Working Age & Pension Age Claimants Summarised Version 2016-2017 1 Index Contents Pages Index 2-3 Introduction 4-6 Council Tax Reduction Scheme

More information

COUNCIL TAX REDUCTION & HOUSING BENEFIT CLAIM FORM

COUNCIL TAX REDUCTION & HOUSING BENEFIT CLAIM FORM Name: Current address: Post code: CHB1 Home telephone number: Mobile number: Email address: IMPORTANT INFORMATION THE MORAY COUNCIL COUNCIL TAX REDUCTION & HOUSING BENEFIT CLAIM FORM 1st contact Issued

More information

Housing Benefit, Council Tax Rebate and Second Adult Rebate Claim Form

Housing Benefit, Council Tax Rebate and Second Adult Rebate Claim Form Housing Benefit, Council Tax Rebate and Second Adult Rebate Claim Form Date Issued 1st Contact Claim Number If you have any special needs that prevent you getting to our offices or you need help in filling

More information

Please use BLOCK LETTERS and place an X in the relevant boxes. Please answer all questions that apply to you.

Please use BLOCK LETTERS and place an X in the relevant boxes. Please answer all questions that apply to you. Application form for Blind Pension Social Welfare Services BP 1 Data Classification R How to complete this application form. Please use this page as a guide to filling in this form. Please use black ball

More information

Help using this PDF claim form

Help using this PDF claim form Help using this PDF claim form You can save data typed into this PDF form if you use Adobe Reader XI or a newer version. This means that you do not have to fill in the form in one session. This form will

More information

Housing Benefit and Council Tax Reduction Claim Form Please detach this information sheet and keep for future reference.

Housing Benefit and Council Tax Reduction Claim Form Please detach this information sheet and keep for future reference. Housing Benefit and Council Tax Reduction Claim Form Please detach this information sheet and keep for future reference. tes for filling in the Housing Benefit and Council Tax Reduction claim form About

More information

Step. Step. Step. to help you fill in your claim form

Step. Step. Step. to help you fill in your claim form Getting your tax credits claim form right Step 1 Documents you may need Make sure you ve got all the documents you need to fill in the claim form. to help you fill in your claim form Step 2 Fill in all

More information

Maternity Allowance. Notes sheet. Please keep these notes for your information, do not return them with your MA1 claim form.

Maternity Allowance. Notes sheet. Please keep these notes for your information, do not return them with your MA1 claim form. Maternity Allowance Please keep these notes for your information, do not return them with your MA1 claim form. Notes sheet l Help if you are expecting a baby and you are or have been employed but cannot

More information

Claim for help with health costs

Claim for help with health costs HC1 Claim for help with health costs Do you find it difficult to pay for health costs? You may be entitled to help through the NHS Low Income Scheme Use this form if you need help with paying for: NHS

More information

Getting your tax credits claim form right. Use these Notes to help you

Getting your tax credits claim form right. Use these Notes to help you Getting your tax credits claim form right Use these Notes to help you TC600 Notes for use from 6 April 2012 You must claim as a couple if you are married, or in a civil partnership. If you are legally

More information

Claiming as a couple. If you don t know what to put for an answer

Claiming as a couple. If you don t know what to put for an answer Getting your tax credits claim form right Use these Notes to help you TC600 Notes for use from 6 April 2015 Claiming as a couple You must claim as a couple if you are married, living with someone as if

More information

State Pension. Your notes booklet. Remember The easy way to claim your State Pension is online or by phone. Important.

State Pension. Your notes booklet. Remember The easy way to claim your State Pension is online or by phone. Important. State Pension Your notes booklet These notes tell you more about the State Pension, and help you fill in your claim form. Remember The easy way to claim your State Pension is online or by phone Visit www.gov.uk/state-pension

More information

APPLICATION FOR FINANCIAL ASSISTANCE

APPLICATION FOR FINANCIAL ASSISTANCE APPLICATION FOR FINANCIAL ASSISTANCE BEFORE COMPLETING THE APPLICATION FORM, PLEASE CAREFULLY READ THE NOTES BELOW. When you have completed the application form, you should detach these notes and keep

More information

A claim form for Housing Benefit and Council Tax Support

A claim form for Housing Benefit and Council Tax Support Date form requested: Local authority office date stamp April 2013 Name: Department: Help notes can be found on pages 20 and 21. You are still liable for your full rent and Council Tax until a decision

More information

Carer s Allowance Claim form

Carer s Allowance Claim form Carer s Allowance Claim form l Use this form to claim Carer s Allowance. l Please read the tes that came with the claim pack before you fill in the form. l The form must be filled in by you, the carer,

More information

Housing Benefit and Council Tax Support Application

Housing Benefit and Council Tax Support Application South Norfolk Council Swan Lane Long Stratton Norwich Norfolk NR15 2XE Housing Benefit and Council Tax Support Application Part 1 About you and your household This is my claim for: Housing Benefit Council

More information

BENEFIT RATES From April 2007

BENEFIT RATES From April 2007 BENEFIT RATES From April 2007 INCOME SUPPORT AND INCOME-BASED JOBSEEKER S ALLOWANCE Capital limits: aged under 60 years - 16,000, disregarded capital - 6,000; for people permanently in residential/nursing

More information

How to Guide (Getting your Deferment Application Form right)

How to Guide (Getting your Deferment Application Form right) How to Guide (Getting your Deferment Application Form right) Use these notes to help you complete your student loan Deferment Application Form If you need any help, please go to www.erudiostudentloans.co.uk

More information

Introduction. Information on transferring payments to the UK 37. National Insurance Number 46. Jobseekers allowance 52.

Introduction. Information on transferring payments to the UK 37. National Insurance Number 46. Jobseekers allowance 52. Introduction XX Information on transferring payments to the UK 37 National Insurance Number 46 Jobseekers allowance 52 Crisis loans 60 Income support 65 Working Tax Credit 73 Statutory Sick Pay 78 Incapacity

More information

Application for Housing Benefit, Council Tax Reduction and Free School Meals

Application for Housing Benefit, Council Tax Reduction and Free School Meals Application for Housing Benefit, Council Tax Reduction and Free School Meals M J Hawes FCCA Head of Finance and Delivery Civic Centre Swansea SA1 3SN 01792 635353 Mae r ffurflen hon ar gael yn Gymraeg

More information

MCL 3. Help with Council Tax. A guide to the Local Council Tax Reduction Scheme

MCL 3. Help with Council Tax. A guide to the Local Council Tax Reduction Scheme MCL 3 Help with Council Tax A guide to the Local Council Tax Reduction Scheme Leaflets and where to get them All leaflets are available free of charge. You can get them from the One Stop Shops, Citizen

More information

Housing Benefit and Council Tax Support application form

Housing Benefit and Council Tax Support application form For office use only Reference Date issued Date received stamp Housing Benefit and Council Tax Support application form If you want to claim help with paying your rent or Council Tax, please fill in this

More information

Housing and Council Tax Benefit

Housing and Council Tax Benefit Factsheet 17 April 2011 Housing and Council Tax Benefit About this factsheet Housing Benefit (HB) helps with rent and Council Tax Benefit (CTB) helps with Council Tax. Both benefits are based on income

More information

Special Needs Grant International Custody Dispute Payment

Special Needs Grant International Custody Dispute Payment Special Needs Grant International Custody Dispute Payment CLIENT NUMBER If you need help with this form call us on % 0800 559 009. Who can get this payment If you need help filling in this form, please

More information

Housing Benefit and Council Tax Reduction Change of Address form.

Housing Benefit and Council Tax Reduction Change of Address form. Housing Benefit and Council Tax Reduction Change of Address form. Name Address Don t delay claim today! Please return this form as quickly as possible, even if you do not have everything we ask for. You

More information

Asylum Support Application Form (ASF1)

Asylum Support Application Form (ASF1) Destitution Message Asylum Support Application Form (ASF1) Under the terms of the Immigration and Asylum Act 1999, the Secretary of State may provide, or arrange for the provision of support for asylum

More information

Housing Benefit & / or Council Tax Reduction Application Form

Housing Benefit & / or Council Tax Reduction Application Form Housing Benefit & / or Council Tax Reduction Application Form for Applicants of Working Age PLEASE COMPLETE THIS FORM IN BLOCK CAPITALS Name Address Are you? (Please tick all that apply): An Owner Occupier

More information

EDf EnErGY trust. APPLiCAtion for financial ASSiStAnCE WHO CAN APPLY FOR A GRANT? HOW CAN THE TRUST HELP?

EDf EnErGY trust. APPLiCAtion for financial ASSiStAnCE WHO CAN APPLY FOR A GRANT? HOW CAN THE TRUST HELP? EDf EnErGY trust APPLiCAtion for financial ASSiStAnCE BEforE CoMPLEtinG the APPLiCAtion form, PLEASE CArEfULLY read the notes BELoW. When you have completed the application form, you should detach these

More information

You need a Personal Public Service Number (PPS No.) before you apply.

You need a Personal Public Service Number (PPS No.) before you apply. Application form for Invalidity Pension Social Welfare Services INV 1 Data Classification R You need a Personal Public Service Number (PPS.) before you apply. How to complete this application form. Please

More information

One-Parent Family Payment

One-Parent Family Payment Application form for One-Parent Family Payment Social Welfare Services OFP 1 Data Classification R Remember, you must have at least one dependent child living with you to qualify for One-Parent Family

More information

A guide to Housing Benefit and Council Tax Reduction. Non-dependants

A guide to Housing Benefit and Council Tax Reduction. Non-dependants A guide to Housing Benefit and Council Tax Reduction Non-dependants Who is a non-dependant? If you are claiming Housing Benefit or Council Tax Reduction, a non-dependant is someone over 18 who normally

More information

Housing benefit & council tax support

Housing benefit & council tax support Housing benefit & council tax support New claim www.portsmouth.gov.uk You must complete and return the form immediately, even if not all the evidence is available. Delay may affect the start date of your

More information

During the course of this year there may be further updates and changes to this Keycard due to the introduction of criminal contributions.

During the course of this year there may be further updates and changes to this Keycard due to the introduction of criminal contributions. Advice and assistance and civil legal aid Keycard 2014 About the Keycard This interim Keycard sets out the various eligibility limits, contributions and clawback levels in advice and assistance and civil

More information

IS8 Homeowners Help with housing costs

IS8 Homeowners Help with housing costs IS8 Homeowners Help with housing costs www.dsdni.gov.uk Homeowners help with housing costs This information sheet provides information on the help which may be available for owner-occupiers who have housing

More information

Medical Card and GP Visit Card Application Form

Medical Card and GP Visit Card Application Form Medical Card and GP Visit Card Form MC1 1 Medical Card and GP Visit Card Application Form MC1 Who should use this form? Anyone applying for either a Medical Card or a GP Visit Card you will be assessed

More information

Carer s Allowance Claim form

Carer s Allowance Claim form Carer s Allowance Claim form i Only use this form to claim Carer s Allowance if you are getting State Pension l Use this form to claim Carer s Allowance. l Please read the tes that came with the claim

More information

SIGNIFICANT FINANCIAL HARDSHIP - KIWISAVER

SIGNIFICANT FINANCIAL HARDSHIP - KIWISAVER SIGNIFICANT FINANCIAL HARDSHIP - KIWISAVER A significant financial hardship (hardship) withdrawal can help during times of financial difficulty; however the purpose of your KiwiSaver savings is for your

More information

Widow s, Widower s or Surviving Civil Partner s (Non-Contributory) Pension

Widow s, Widower s or Surviving Civil Partner s (Non-Contributory) Pension Application form for Social Welfare Services WP 1 Data Classification R Widow s, Widower s or Surviving Civil Partner s (n-contributory) Pension You need a Personal Public Service Number (PPS.) before

More information

Deferred Loan Application

Deferred Loan Application Deferred Loan Application MINISTRY OF HEALTH MANATU HAUO RA Deferred Loans When a residential care loan becomes repayable, a deferred loan can be offered to people in certain circumstances. Residential

More information

An introduction WTC1

An introduction WTC1 Child Tax Credit and Working Tax Credit An introduction WTC1 Contents Introduction Who can claim 1 Child Tax Credit Who can claim 3 Full-time, non-advanced education 4 Approved training 4 How much you

More information