A Claim Form for Housing Benefit and Council Tax Reduction

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "A Claim Form for Housing Benefit and Council Tax Reduction"

Transcription

1 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 3YG. Important We will use the information you give in this form, and in any supporting evidence you send us, to process your claim for Housing Benefit and Council Tax Reduction. By law, we may pass the information to other agencies or organisations such as the Department for Work and Pensions, the Employment Service and Her Majesty s Revenues and Custom (HMRC). By law, we may also check the information you have provided, or information provided about you by someone else, against other information we already have. We may also ask other agencies, organisations, local authorities or government departments what information they have about you to ensure: it is accurate; to prevent or detect crime; and to protect public funds. We will not give information about you to anyone else, or use information about you for other purposes, unless the law allows us to. East Lothian Council is the data controller for the purposes of the Data Protection Act East Lothian Council is committed to treating all people equally. If you feel we have treated you unfairly, please contact our Equal Opportunities Officer on Use black ink to fill in the form. 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. Please write clearly and answer all the questions. If a question does not apply to you, write N/A (not applicable). Name: Address: Please tick the appropriate boxes below: I own the home I live in I am a council tenant Post Code: Telephone: You do not have to tell us your phone number but it may speed up your claim. I am a private tenant I am a Housing Association tenant I live with one of the above I wish to claim council tax Single Persons Discount Is this your first claim at this address? Yes No If YES, what date did you move in? What was your previous address? Did you claim benefit there? Yes No Did you own this property? Did you rent this property? Yes No Yes No 1

2 Part 1 About you and your partner By partner we mean the person you are married to, or live with as if you were married, or have a civil partnership with. Your personal details You Your partner Marital status Title (Mr/Mrs/Ms/Miss) Last name First name Date of birth Letters Numbers Letter Letters Numbers Letter National Insurance Number (You can find this on pay slips or letters from the Department for Work and Pensions or Her Majesty s Revenues and Custom (HMRC). We cannot decide your claim if we do not have your National Insurance Number.) Have you lived in the UK for less than 2 years? If YES, what is your nationality? (We will write to you about this) Yes No Yes No Which country did you live in? When did you come to live in the United Kingdom? How long do you plan to stay? Do you still have bank accounts or property overseas? You and your partner s health You Your partner Are you long-term sick or disabled Yes No Yes No and incapable of work? Are you registered or certified blind? Yes No Yes No Does anyone get Carer s Allowance Yes No Yes No to look after you or your partner? If YES, what is their name and address? Are you in hospital at the moment? Yes No Yes No If YES, please state the date you went in? When do you expect to come out? 2

3 You Your partner Please tick if you or your partner are: a student (also complete 6b) a student (also complete 6b) a student nurse a student nurse an apprentice an apprentice on youth training on youth training in legal custody in legal custody severely mentally impaired severely mentally impaired PROOF We need to see two original items of identification (one photo ID if possible) before we can assess all new claims. We cannot accept photocopied documents. These could include: driving licence; national insurance card; valid passport; recent credit card bill; birth certificate; medical card; DWP letter; marriage certificate; recent payslip. If you do not have two items from this list, please contact us and we will advise you further. If you do not have this proof now, you can send or bring it in to us within one calendar month. You must complete this form and return it straight away. We need to see the original proof of your national insurance number before we can assess your claim. This could be P45, P60, payslips, income tax letter, DWP letter of award, RD3 national insurance card. IF YOU DO NOT YOU COULD LOSE BENEFIT/REDUCTION. Part 2 About children You may be able to get extra benefit for children you receive child benefit for, if they normally live with you and they are: i) under 16; ii) 16 or over, but under 20 and in full time education or approved training; iii) aged 16 or 17 and registered for work or youth training. Do you want to claim for any children? Yes No Tell us about the children If NO, go to Part 3 you want to claim for If you want to claim for more than three children, use a separate sheet of paper. If you are sending a separate sheet of paper, clearly note on it your name and address and tick this box Last name First names Date of birth What is the child s sex? The child s relationship to you Usual address if different from yours First child Second child Third child School attended Child Benefit Number 3

4 Who gets the Child Benefit for them? (We need to see proof of this) Is the child registered blind or Yes No Yes No Yes No getting Disability Living Allowance or Personal Independence Payments (PIP)? Do you pay any child minding Yes No Yes No Yes No costs for this child? Tell us the name, address and registration number of the minder How much do you pay a week? We need to see proof (see note below) Do you have a child about to Yes No Yes No Yes No leave school? If YES, what is their expected leaving date? PROOF We must have original proof of any money you pay for registered childcare costs. If you do not have this proof now, you can send or bring it in to us within one calendar month. You must complete this form and return it straight away. IF YOU DO NOT YOU COULD LOSE BENEFIT/REDUCTION. Part 3 About other people who live with you Please give details of anyone else who lives in your home. They could be relatives, friends or boarders. Do any adults normally live with you and your partner? Yes No (By adults we mean people over 16 for If YES, tell us about all the If NO, go to Part 4 whom no one receives Child Benefit ). adults, except your partner, who usually live with you. If you want to tell us about more than three people, use a separate piece of paper. If you are sending a separate sheet of paper, clearly note on it your name and address and tick this box Are any of the people who Yes No normally live with you married to each other or living together as if they were married? If YES, tell us their names. is the partner of is the partner of Now tell us about all the people who normally live with you and your partner. First person Second person Third person Last name First names Date of birth 4 Their relationship to you For example, aunt, brother, daughter, father, grandmother, stepdaughter, joint tenant, joint owner or friend

5 National Insurance Number Do they get Income Support or Yes No Yes No Yes No Income Based Jobseeker s Allowance or Employment and Support Allowance? Do they get Disability Living Allowance Yes No Yes No Yes No or Attendance Allowance or Personal Independence Payments (PIP) or are they registered blind? Are they a full time student, Yes No Yes No Yes No a student nurse, a care worker, an apprentice or on youth training? Do they pay rent or money for board Yes No Yes No Yes No and lodgings to you or your partner? Are they Severely Mentally Impaired? Yes No Yes No Yes No Are they in legal custody at Yes No Yes No Yes No the moment? If YES, when are they expected to come out? Are they in hospital at the moment? Yes No Yes No Yes No If YES, when did they go in? When are they expected to come out? Do they normally work for Yes No Yes No Yes No 16 hours or more a week? If YES, tell us about their earnings before deductions for things like National Insurance. We need to see proof of their earnings. Do they have any other income Yes No Yes No Yes No or savings at all? If YES, tell us their other income before deductions for things like Tax and National Insurance. We need to see proof of their income. PROOF We must have proof of the income and savings of all the people you have told us about in this section. This will help us work out any benefit you could get for Second Adult Rebate. If you do not provide this proof, you will NOT be considered for Second Adult Rebate and the highest rate of non-dependant deduction will be taken off any benefit paid to you. If you do not have this proof now, you can send or bring it in to us within one calendar month. You must complete this form and return it straight away. IF YOU DO NOT YOU COULD LOSE BENEFIT/REDUCTION. 5

6 Part 4 Capital, bank accounts, savings and investments By capital we mean any money you have in banks or buildings societies, INCLUDING your current account (if you have one). This also means investments like stocks and shares, and property or land that you own (other than the home you live in). Do you, or your partner, have any capital, Yes No bank accounts, savings or investments? Answer all the questions If NO, go to Part 5 in this part. (This includes current accounts and savings accounts with a bank or building society, post office accounts, premium bonds or stocks and shares) We need to see proof of all the capital, savings and investments. Do you or your partner have any bank accounts? Yes No (current and/or savings) Tell us about bank accounts. If there are more than 3 bank accounts, tell us about the others on a separate piece of paper and send it with this form. If you are sending a separate sheet of paper, clearly note on it your name and address and tick this box Name of bank Account number Whose name is the account in? How much is in the account? Do you or your partner have any building Yes No society accounts? Tell us about these building society accounts. If there are more than 3 building society accounts, tell us about the others on a separate piece of paper and send it with this form. If you are sending a separate sheet of paper, clearly note on it your name and address and tick this box Name of building society Account number Whose name is the account in? How much is in the account? Do you or your partner have any Yes No post office accounts? (This includes savings accounts and girobank accounts) Tell us about these post office accounts. 6

7 If there are more than 3 post office accounts, tell us about the others on a separate piece of paper and send it with this form. If you are sending a separate sheet of paper, clearly note on it your name and address and tick this box Type of account Account number Whose name is the account in? How much is in the account? You Your partner Do you or your partner Yes No Yes No have any Premium Bonds? Do you or your partner Yes No Yes No have any National Savings Value: Value: Certificates? How many? How many? (Please provide us with the original certificates as proof) Do you or your partner Yes No Yes No have any Stocks, Shares, Bonds Company name: Company name: or Unit Trusts? How many? How many? Do you or your partner Yes No Yes No have any other capital, savings If YES, tell us about this: If YES, tell us about this: or investments? (Tell us about any TOISA s or ISA's or PEPS here) Do you or your partner own Yes No Yes No or partly own any land or property If YES, tell us the address If YES, tell us the address other than the home you live in? PROOF We must see proof of all your capital before we can assess your claim. We must see original documents, like a full up to date bank statement showing at least 8 weeks transactions, building society books, savings book, savings certificates, share certificates and property deeds. If you don t have this proof now, you can send or bring it in to us within one calendar month. You must complete this form and return it straight away. IF YOU DO NOT YOU COULD LOSE BENEFIT/REDUCTION. Part 5 About working Do you or your partner work for an employer? Yes No Answer the following If NO, go to Part 6 questions. If you work for more than one employer, tell us about the employers on another piece of paper and send it with this form. If you are sending a separate sheet of paper, clearly note on it your name and address and tick this box 7

8 You Your partner What kind of work do you do? What is your employer s name and address? When did you start this job? Are you employed for a Yes No Yes No limited period? If YES, what date will it end? How often do you get paid? Every Every How much do you get paid? When was your last pay rise? How many hours a week do you work? Are you getting Statutory Sick Pay Yes No Yes No (SSP) or Statutory Maternity Pay (SMP) from your employer at the moment? Are you getting any other sick pay Yes No Yes No or maternity pay from your employer at the moment? Do you pay into a private or Yes No Yes No company pension scheme? If YES, how much If YES, how much How often? How often? Do you get tips, bonuses or Yes No Yes No commission? If YES, how much If YES, how much How often? How often? PROOF We must see original proof of all your earnings before we can assess your claim. We cannot accept photocopies. If you do not give us sufficient proof of your earnings, we may have to contact your employer. if you are paid each week, send or bring in to us your last 5 weekly payslips. if you are paid two weekly, send or bring in to us your last 3 fortnightly payslips. if you are paid each month, send or bring in to us your last 2 monthly payslips. if you do not have this proof, ask your employer to fill in and sign the Employer s Certificate on page 9. then return it to us with your last payslip. If you do not have this proof now, you can send or bring it in to us within one calendar month. You must complete this form and return it straight away. IF YOU DO NOT YOU COULD LOSE BENEFIT/REDUCTION. 8

9 East Lothian Council, Support Services, PO Box 13261, Haddington, East Lothian EH41 3YG. Certificate of Earned Income/Benefit Income You Only fill in this form if you cannot give us your payslips or evidence of your state benefits. Please fill in your personal details below. If you are working, ask your employer to fill in and stamp section A. If you get state benefits, ask an officer at the DWP to fill in and stamp section B. Once you have done this, return the certificate to the address above. Name: Address: Section A To be completed if you are working Note to Employer: Please fill in section A of this certificate and return to your employee. Thank you for your help. East Lothian Council, Support Services, PO Box 13261, Haddington, East Lothian EH41 3YG. Certificate of Earned Income/Benefit Income Your partner Only fill in this form if you cannot give us your payslips or evidence of your state benefits. Please fill in your personal details below. If you are working, ask your employer to fill in and stamp section A. If you get state benefits, ask an officer at the DWP to fill in and stamp section B. Once you have done this, return the certificate to the address above. Name: Address: Section A To be completed if you are working Note to Employer: Please fill in section A of this certificate and return to your employee. Thank you for your help. Employee / works number Please tick the box to say how often the employee is paid: weekly fortnightly 4 weekly calendar monthly other (please state) Normal basic wage: Normal hours worked: Method of payment: Pay period Gross pay Gross pay National Superannuation Income Tax ending to date Insurance or pension Employee / works number Please tick the box to say how often the employee is paid: weekly fortnightly 4 weekly calendar monthly other (please state) Normal basic wage: Normal hours worked: Method of payment: Pay period Gross pay Gross pay National Superannuation Income Tax ending to date Insurance or pension 9

10 Your partner If statutory Sick Pay or Maternity Pay is included in the gross pay, please indicate which is paid and how much. Sick Pay Maternity Pay Name and business address of employer Employer s signature: Date: Please endorse this certificate with the employer s authorisation stamp below: Section B To be completed if you get state benefit Note to DWP Officer: Please fill in the requested details below and return to the claimant. Thank you for your help. Address of DWP claim: Type of benefit Date started Date benefit ends Weekly amounts Signature of DWP Officer: Date: Please endorse this certificate with the DWP authorisation stamp below: You If statutory Sick Pay or Maternity Pay is included in the gross pay, please indicate which is paid and how much. Sick Pay Maternity Pay Name and business address of employer Employer s signature: Date: Please endorse this certificate with the employer s authorisation stamp below: Section B To be completed if you get state benefit Note to DWP Officer: Please fill in the requested details below and return to the claimant. Thank you for your help. Address of DWP claim: Type of benefit Date started Date benefit ends Weekly amounts Signature of DWP Officer: Date: Please endorse this certificate with the DWP authorisation stamp below: 10

11 Part 6 About any other work Do you or your partner do any other Yes No work at all? If YES, answer the questions If NO, go to Part 7 (This could be voluntary work on this page. or any other work, even if it is not paid). You Your partner What kind of work do you do? What is the name and address of the person you do this work for? When did you start this work? Do you get paid? Yes No Yes No If you only get expenses or tips, Still tick Yes and give details. If YES, how much? If YES, how much? How often? How often? PROOF We must see original proof of all your earnings before we can assess your claim. We cannot accept photocopies. If you don t give us sufficient proof of your earnings, we may have to contact your employer. If you do not have this proof now, you can send or bring it in to us within one calendar month. You must complete this form and return it straight away. IF YOU DO NOT YOU COULD LOSE BENEFIT/REDUCTION. Part 6b Are you a student? (student means someone who is in further education and beyond school level). Are you or your partner a student? No If NO, go to Part 7 Yes If YES, give details below STUDENT INCOME Value of grant You Your partner Value of any money paid by parents or deed of covenant COURSE DETAILS Name and type of course Date academic year starts Date academic year ends When does the whole course end? You Your partner 11

12 Part 7 About being self-employed Are you or your partner self-employed? Yes No If YES, answer the questions on this page. If NO, go to Part 8 You must send us your trading accounts for the last financial year. If you have only recently set up the business and do not have a full year s accounts, we will need to see some other proof of your income. We will write to you about this. You Your partner What kind of work do you do? When did the business start? What is the business address? Are there any other partners Yes No Yes No in the business? How many hours a week do you work? Do you get a business Yes No Yes No start up allowance? Do you pay into a private Yes No Yes No pension scheme? PROOF We must see original proof of all your earnings before we can assess your claim. We cannot accept photocopies. Please send or bring in your most recent audited accounts. If you have been self-employed for less than a year, we will need proof of the estimated earnings you have told us about. We need to see your latest personal and business bank statements and your latest tax assessment. If we need further proof we will ask you for this as soon as possible. If you do not have this proof now you can send or bring it in to us within one calendar month. You must complete this form and return it straight away. IF YOU DO NOT YOU COULD LOSE BENEFIT/REDUCTION. 12

13 Part 8 About Income Support, Income Based Jobseeker s Allowance, Employment and Support Allowance (income related) and Pension Credit Are you or your partner getting or waiting to hear Yes No about a claim for Income Support or Income Based If YES, answer the If NO, go to Part 9 Jobseeker s Allowance or Employment and Support following questions Allowance (income related) or Pension Credit? You Your partner Are you or your partner getting Income Yes No Yes No Support or Income Based Jobseeker s Allowance at the moment? When did you start getting it? Are you or your partner getting Yes No Yes No Employment and Support Allowance (income related) at the moment? When did you start getting it? Are you or your partner getting Yes No Yes No Pension Credit at the moment? When did you start getting it? Are you or your partner getting Yes No Yes No guaranteed element of Pension Credit? When did you start getting it? Are you or your partner getting the Yes No Yes No savings element of Pension Credit? When did you start getting it? PROOF We must see original proof of all the payments you have told us about before we can assess your claim. We cannot accept photocopies. If you do not have this proof now you can send or bring it in to us within one calendar month. You must complete this form and return it straight away. IF YOU DO NOT YOU COULD LOSE BENEFIT/REDUCTION. 13

14 Part 9 About benefit and pensions Are you or your partner getting any benefit or waiting Yes No to hear about benefits you have claimed? If YES, tell us If NO, go to Part 10 about the benefit If you are getting or have claimed any benefit that is not listed, tell us about it at the bottom of the list. You Your partner Waiting to How much? How often? Waiting to How much? How often? hear ( ) ( ) hear ( ) ( ) Attendance Allowance Carer s Allowance Child Benefit Child Tax Credit Disability Living Allowance Care Disability Living Allowance Mobility Employment and Support Allowance (contribution based) Guardians Allowance Incapacity Benefit (long term) Incapacity Benefit (short term lower rate) Incapacity Benefit (short term high rate) Industrial Death Benefit Industrial Injuries Disablement Benefit (Contribution based) Jobseeker s Allowance Maternity Allowance Personal Independence Payments (PIP) Retirement Pension Severe Disablement Allowance Statutory Sick Pay War Disablement Benefit War Pension War Widow s Pension Widow s or Widower s Benefit Working Tax Credit 14

15 Part 10 About other money coming in Do you or your partner or any children you are claiming Yes No for, have any money coming in that you have not If YES, tell us about If NO, go to Part 11 already told us about on this form? the benefit below (This includes any money like pensions from a previous employer, cash-in-lieu payments, maintenance or child support for you, your partner or any of the children, you have told us about on this form; and any cash payments. Also tell us about any money you get from people living in your house as boarders, lodgers or subtenants. You do not have to tell us about payments from the Independent Living Fund, the Eileen Trust or the MacFarlane Trust.) Other money 1 You Your partner What is the money for? Who gets it? How much do they get? How often? Other money 2 What is the money for? Who gets it? How much do they get? How often? Other money 3 What is the money for? Who gets it? How much do they get? How often? Does anyone owe money to you, your partner or any children you are claiming for? Yes No If YES, what for? How much? PROOF Before we can assess your claim we need to see original proof of all the unearned income you have told us about. We cannot accept photocopies. We need to see proof that shows us how much unearned income you get, and how often you get it. This could be something like a recent payslip, a DWP letter along with a full latest bank statement. Alternatively, ask your DWP officer to fill in and sign the Benefits Certificate on page 9, then return it to us as soon as possible. If you do not have this proof now, you can send or bring it in to us within one calendar month. You must complete this form and return it straight away. IF YOU DO NOT YOU COULD LOSE BENEFIT/REDUCTION. 15

16 Part 11 About rent Do you pay rent for your home? Yes If YES, complete this section No If NO, go to Part 14 Do you pay rent to the council? Yes If YES, go to Part 12 When did you start renting your home? When did you move to this address? If you have not moved in yet, tell us when you expect to move in? Does your landlord live in the property? Yes No What sort of tenancy do you have? For example, shorthold, tied rent etc. How long is the tenancy for? to Please tick to show if the property is let as: furnished partly furnished minimally furnished unfurnished Does your home have central heating? Yes No Who pays for decorating the inside of your home? How much rent do you pay? every Does anyone else share the rent with you and your partner? No Yes Tell us their names Has your rent changed in the last 12 months? Have you owned this property within the last 5 years? Do you have any weeks when you do not have to pay rent? No Yes Send us proof of the date it changed, and how much it changed Yes No Yes No 16

17 Are you in arrears with your rent? Yes No If you have ticked yes, state how much If you have ticked yes, state period If you know in advance when you rent is due to be increased, please enter the date Who pays the Council Tax on your home? Are you living away from home at the moment? you and your partner your landlord someone else No Yes Tell us why you are not living at home When did you last live at home?.../.../... When do you expect to go back home?.../.../... Tell us the address of where you are living at the moment If your home has been sub let, tell us who lives there now Does the rent include money for: meals heating lighting hot water fuel for cooking laundry cleaning rooms or windows No Yes How much? For which meals? Breakfast Please tick Lunch Dinner No Yes How much? No Yes How much? No Yes How much? No Yes How much? No Yes How much? No Yes How much? 17

18 gardening garage or parking space Do you have to rent the garage as part of your tenancy agreement? personal care and support No Yes How much? No Yes How much? Yes No No Yes How much? Do you pay any service charges No separate from your rent? Yes How much? For example, for cleaning or lighting in What for? shared areas, an alarm system, a warden, general counselling or support meals or lift maintenance What is your landlord s full name and address? By landlord we mean the person or organisation who owns the property you live in. What is your landlord s registration number? If your landlord has an agent tell us their full name and address. Agent means the person or organisation who you actually pay your rent to. Are you, or your partner or No children related to your Yes What is the relationship? landlord or agent, or to your landlord s partner or the agent s partner? Related includes related through marriage, even if the marriage has ended. PROOF Before we can assess your claim we need to see original proof of your rent. This should be a tenancy agreement, lease, rent book or letter from your landlord. If your rent has been registered with the rent officer, we need to see the notice of registration (form R05). If the proof you give us is not sufficient, we may contact your landlord. If you do not have this proof now, you can send or bring it in to us within one calendar month. You must complete this form and return it straight away. IF YOU DO NOT YOU COULD LOSE BENEFIT/REDUCTION. 18

19 Part 12 About where you live What sort of building do you live in? detached house flat in a block caravan, mobile home or houseboat semi detached house flat in a house board and lodgings terraced house flat over a shop hotel maisonette bedsit or room residential nursing home bungalow hostel residential care home other please state Which floor is your home on? 2nd floor 1st floor ground floor basement Other please specify Do you and your household occupy only part of the No Yes building? Where in the building do you live? At the front In the middle At the back How many rooms are there In the whole Just for you and That you share with in the building? building your household other people living room bedsitting room bedrooms bathrooms toilets kitchens other rooms Do you use your home for business? Do you have a main home somewhere else? (If your main home is elsewhere in the UK or abroad, tick yes, even if you do not pay rent for it.) Yes No No Yes What is the address? How much do you pay for this home? 19

20 Part 13 Other Information Sharing information with your landlord could help us deal with your claim more quickly and reduce the risk of you falling behind with your rent because of your claim being delayed. If we have your permission to contact your landlord, this may help speed up your claim. If you give us permission, we would be able to tell your landlord whether: you have claimed Housing Benefit we have made a decision on your claim we have made a payment to you; or we need more information to make a decision on your claim, and what that information may be We will not give your landlord any information about: your personal or household circumstances; or your financial circumstances You can withdraw your permission at any time. It will not affect your claim if you do not give us permission to discuss your claim with your landlord. If you want to give us your permission to discuss your claim with your landlord, please sign below. I give East Lothian Council permission to share any information about the progress of this housing benefit claim with my landlord or their nominated representative. You or your partner s signature: Date: Part 14 Paying your Housing Benefit If you are a council tenant, your council will pay any Housing Benefit you are awarded into your rent account. If you are not a council tenant and are awarded Housing Benefit, in most cases you can choose where to have your money paid. Your council can arrange to pay your money: straight into a bank or building society by cheque If you are awarded Council Tax Reduction, we will pay this into your council tax account. In some cases we can pay your landlord direct. Payment direct into a bank account We recommend that you get your money in this way because: it is safe and secure it is convenient you decide when and how much you want to withdraw using an account may help you to save you could have regular bills paid from some accounts (this could save you money but you will need to make sure that there is enough money in your account to pay the bills if not, you may be charged a fee) you can get your money from many different places 20

21 The account can be: in your name in the name of your partner (we use partner to mean a person you are married to or a person you live with as if you are married to, or a civil partner or a person you live with as if you are civil partners) in your name and your partner s name in the name of the person acting on your behalf in your name and the name of the person acting on your behalf If we cannot pay into your account, we will pay you by cheque. Please note that we cannot make payments into post office card accounts. You must tell us how you want us to pay your Housing Benefit. Would you like your Housing Benefit paid straight into a bank account or by cheque? Tick the appropriate box. straight into a bank account by cheque Private tenants getting Local Housing Allowance (LHA) Your benefit will be paid directly to you. If you feel there is a reason why you could not manage your own rent payments you should contact us for a Direct Payment to Landlord form. Name of bank or building society Address Account name Account number Sort code Housing Association and tenants exempt from Local Housing Allowance (LHA) Housing Benefit can be paid to you or direct to your landlord (please complete either Option 1 or Option 2) OPTION 1: I want my Housing Benefit paid into my bank or building society Name of bank or building society Address Account name Account number Sort code OPTION 2: I want my Housing Benefit paid direct to my landlord s bank account Name of bank or building society Address Account name Account number Sort code 21

22 Part 15 Anything else you need to tell us? Use this box to tell us anything else you think we should know about. Use a separate sheet and attach it to this form if you need to. If you are sending a separate sheet of paper, tick this box Part 16 Scribe By scribe we mean someone who writes the claimant s details on the form because they are having difficulty filling it in for themselves. A scribe will usually be a council advisor or other advice worker. If you are acting as a scribe, please give your details below. If you are in any doubt about whether this section applies to you or not, please call the benefit section for advice on or Note: When you act as a scribe, you are not responsible for the person s benefit claim. The claimant must still sign the declaration below. I have read back to the customer the entries I made on the form based on the information given by them. The customer agreed they were correct. Name Occupation Employer Signature Claimant s signature 22

23 Part 17 Declaration Even if someone else has filled in this form for you, you must sign the declaration if you can. If you have a partner, they must sign this declaration as well. Please read this declaration carefully before you sign and date it. This is my claim for Council Tax Reduction/Housing Benefit/Single Person Discount. I declare that the information I have given on this form is correct and complete. I authorise East Lothian Council to make any necessary enquiries to check the information is true. I authorise East Lothian Council to cross-check the information I have given with other sections within East Lothian Council, Rent Service Scotland and other benefit authorities within the terms of the Data Protection Act. I understand that the data held by this authority in respect of my Benefit/Reduction Application will be used for cross-system and cross-authority comparison purposes for the prevention and detection of fraud. I understand that any information given on this form can be used for debt recovery purposes. I understand that if I give information that is incorrect or incomplete, I may be prosecuted. I must let East Lothian Council know in writing of any changes of circumstances which may affect my claim. Examples of changes of circumstances of which you must notify us of are listed in the separate guidance notes. I understand that if I fail to inform East Lothian Council of any changes, this may involve the recovery of any overpayment of benefit and also lead to possible prosecution or penalty. I understand that the data held by this authority in respect of my Benefit Application will be passed onto the Credit Reference Agency. I understand that East Lothian Council aims to provide a good quality service to me and all its customers to help ensure our safety and wellbeing. To assist East Lothian Council staff to deliver the best service possible I agree to my personal details being shared between relevant services within the Council. These services may include Housing and Environment, Adult Wellbeing, Children s Wellbeing, Finance and Education. I have read and understood the above declaration Signature of person claiming: Signature of partner/spouse/joint tenant as appropriate: Date Date 23

24 Your representative If this form has been filled in by someone other than the person claiming: Please tell us why you are filling in this form for the person claiming. Name of representative Address of representative Signature of representative Date Relationship to the person claiming Note: When you agree to act as a representative, you must take full responsibility for the person s benefit claim. This means you must make the claim and tell us of any changes in the person s circumstances. Checklist This section is to help you make sure you have filled in the form completely. IF NOT, YOUR CLAIM WILL BE DELAYED AND YOU COULD LOSE BENEFIT/REDUCTION. Is your full name and address on the first page? Have you enclosed proof of all money coming in? Have you enclosed proof of all savings and capital? Have you enclosed your tenancy agreement and rent book? (only if paying to a private landlord or housing association) Have you signed the declaration on page 23? Have you enclosed proof of your ID? If you have answered YES to all of the above, or are sending in proof within one calendar month, your application is ready. You can send your application to the address on the front page or bring it in person to any of the area offices listed in the notes for completing a claim form for Housing Benefit and Council Tax Reduction. 24

25 Equalities REVENUES: Equality Monitoring Document East Lothian Council, Support Services, PO Box 13261, Haddington, East Lothian, EH41 3YG. To link our information with national statistics, the questions in this section have been mainly taken from the 2001 Census. Please complete these sections. 1. Sex: Male Female I prefer not to answer 2. Date of Birth: (DD/MM/YYYY) I prefer not to answer 3. Marital Status: Single (never married) Married Cohabiting Widowed Separated Divorced I prefer not to answer 4. How do you identify your sexual orientation? Bisexual Gay/Lesbian Heterosexual I prefer not to answer 5. Disability: The Disability Discrimination Act 1995 defines a disability as a physical or mental impairment which has a substantial or long term adverse effect on a person s ability to carry out normal day-to-day activities. Using this definition as a guide, do you consider yourself to have a disability? Yes No If yes please give details: I prefer not to answer 6. What religion, religious denomination or body do you belong to? None Church of Scotland Roman Catholic Other Christian (please give details) Buddhist Hindu Sikh Muslim Jewish Another religion (please give details) I prefer not to answer 25

26 Ethnic Origin Choose a section A-E and complete. A White Scottish English Irish Welsh Other (please give details) B Mixed Background Any mixed background (please give details) C Asian (Asian Scottish, Asian English, Asian Welsh, Other Asian British) Indian Pakistani Bangladeshi Chinese D Black (Black Scottish, Black English, Black Welsh, or other Black British) Caribbean African E Other Ethnic Background (please give details) Other White Background (please give details) Any other Asian background (please give details) Any other Black Background (please give details) I prefer not to answer 26

27 CR1632 3M 313

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

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 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

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 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

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

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

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

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 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

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

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

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

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

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

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

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 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

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

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

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

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

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

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

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

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

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

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

Please sign here. What is the relationship?

Please sign here. What is the relationship? Housing Benefit Rent Details form We need some more information about your rent so that we can decide your Housing Benefit. Please complete this form and return it to Customer Accounts, Watling House,

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

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

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 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

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

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

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

A CLAIM FOR DISCRETIONARY HOUSING PAYMENTS (DHP) Claim Ref:

A CLAIM FOR DISCRETIONARY HOUSING PAYMENTS (DHP) Claim Ref: A CLAIM FOR DISCRETIONARY HOUSING PAYMENTS (DHP) Claim Ref: SECTION 1 INFORMATION If you are getting Housing Benefit and Local Council Tax Support but you are still having problems meeting your rent and

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

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

Application form for Housing Benefit (including Local Housing Allowance) and/or Council Tax Support (including Second Adult Discount)

Application form for Housing Benefit (including Local Housing Allowance) and/or Council Tax Support (including Second Adult Discount) www.islington.gov.uk Application form for Housing Benefit (including Local Housing Allowance) and/or Council Tax Support (including Second Adult Discount) If you are on a low income, you could get Housing

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

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

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

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

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

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

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

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

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

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

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

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

Change of Address Form Help with your Rent and Council Tax

Change of Address Form Help with your Rent and Council Tax Change of Address Form Help with your Rent and Council Tax Please do not write in this box. It is for office use only. Office receipt date stamp of issue: Please read all of the notes shown on this page

More information

IMPORTANT INFORMATION

IMPORTANT INFORMATION FOR OFFICIAL USE ONLY Receipt Number Date issued Date Received Returned for Cert. HOUSING BENEFIT, COUNCIL TAX BENEFIT - (For Applicants of Pensionable Age only) This form should only be completed to advise

More information

Housing Benefit, Council Tax Reduction and Free School Meals Notification of Change of Address

Housing Benefit, Council Tax Reduction and Free School Meals Notification of Change of Address Housing Benefit, Council Tax Reduction and Free School Meals tification of Change of Address Mae r ffurflen hon ar gael yn Gymraeg o Ganolfan Ddinesig This form is also available in large print from the

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

Housing benefit and council tax reduction application form

Housing benefit and council tax reduction application form For Official use only Date Requested... Date Issued... Originating Office... Claim Reference... Name... Address......... Postcode... Housing benefit and council tax reduction application form Please use

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

Benefit claim form. Please read the benefit information booklet supplied with this form before completing your

Benefit claim form. Please read the benefit information booklet supplied with this form before completing your Please read the benefit information booklet supplied with this form before completing your claim Keep it safe as you may need to refer to it in future or translated into another language please call us

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

Visit any of the One Stop Centres listed on page 4 of the benefit information booklet

Visit any of the One Stop Centres listed on page 4 of the benefit information booklet Please read the benefit information booklet supplied with this form before completing your claim Keep it safe as you may need to refer to it in future or translated into another language please call us

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

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

APPLICATION FORM. Application for Housing Registration

APPLICATION FORM. Application for Housing Registration APPLICATION FORM Application for Housing Registration The purpose of this application form is to register your need for housing. Registration does not guarantee that you will be made an offer of accommodation.

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

Application form for Housing Benefit, Council Tax Reduction and Second Adult Rebate

Application form for Housing Benefit, Council Tax Reduction and Second Adult Rebate HC BEN 1 Application form for Housing Benefit, Council Tax Reduction and Second Adult Rebate If you and/or your partner have capital of more than 16,000 and you or your partner are in receipt of Job Seeker

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

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

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

Registration Form National Housing Trust properties at The Glen Coalsnaughton

Registration Form National Housing Trust properties at The Glen Coalsnaughton Ochil View Housing Association Ochil House Marshill Alloa FK101AB 01259 722899 customerservices@ochilviewha.co.uk Registration Form National Housing Trust properties at The Glen Coalsnaughton Mid-market

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

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

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

More information

Claims Management Claim Form. When you have filled in the form, please send it to us at:

Claims Management Claim Form. When you have filled in the form, please send it to us at: For our use only.../... Claims Management Claim Form When you have filled in the form, please send it to us at: Solicitors Regulation Authority Claims Management The Cube 199 Wharfside Street Birmingham

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

Help with your Rent and Council Tax Change of Address form

Help with your Rent and Council Tax Change of Address form Help with your Rent and Council Tax Change of Address form Name: New address: For office use only Reference : Date Stamp Postcode: Prop ref of new address: Date you moved into your new address: Complete

More information

www.helptobuysw.org.uk

www.helptobuysw.org.uk Help to Buy South West Application Form Please circle the correct answers Would you consider buying a home? Would you consider renting a home? Yes / No Yes / No I/We can confirm that our household income

More information

A claim form for Discretionary Housing Payment

A claim form for Discretionary Housing Payment Revised March 2013 Revenues & Benefits Service Hackney Service Centre, 1 Hillman Street, London E8 1DY Phone enquiries: 020 8356 3399 Fax: 020 8356 3655 Textphone: 020 8356 3725 Counter enquiries: Monday

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

APPLICATION FOR FINANCIAL ASSISTANCE

APPLICATION FOR FINANCIAL ASSISTANCE APPLICATION FOR FINANCIAL ASSISTANCE ALTERNATIVELY APPLY ONLINE VIA THE FUND S WEBSITE WWW.NPOWERENERGYFUND.COM BEFORE COMPLETING THE APPLICATION FORM, PLEASE CAREFULLY READ THE NOTES BELOW. When you have

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

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 If you need help or more information, please contact Hounslow Revenue Services either by phone on 020 8583 4242 or or in in person at at any any

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 List Application

Housing List Application Answer all questions on this form fully & truthfully or your application will be delayed. Please use a black pen and write in BLOCK CAPITALS. If you need help filling in this form please contact 020 7364

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

The City of Cardiff Council Notes for filling in the Housing Benefit / Council Tax Reduction / Free School Meals claim form

The City of Cardiff Council Notes for filling in the Housing Benefit / Council Tax Reduction / Free School Meals claim form The City of Cardiff Council tes for filling in the Housing Benefit / Council Tax Reduction / Free School Meals claim form Name and address Claim reference About this form This claim form has been specially

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

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

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

Housing Benefit and Council Tax Benefit. Self employed earnings information form Please read the notes at part E before completing this form FOR OFFICE USE ONLY Date of issue Claim reference number Please return this form to: The Benefits Team Tel: 0118 9746000 PO Box 152 Fax: 0118 9195124 Shute End Minicom: Typetalk 0118 9746991 Wokingham

More information

Housing Benefit & Council Tax Reduction for Pensioners Revenues & Benefits Service Information Booklet

Housing Benefit & Council Tax Reduction for Pensioners Revenues & Benefits Service Information Booklet Benefits Housing Benefit & Council Tax Reduction for Pensioners Revenues & Benefits Service Information Booklet Contents Page How do I access the service? 3 What is Council Tax Reduction and who can claim

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

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

Prevent unauthorised deductions Antenatal care. Failure to allow time off for trade union activities/safety rep duties

Prevent unauthorised deductions Antenatal care. Failure to allow time off for trade union activities/safety rep duties Fees and Remissions Although this form is not part of the ET1 it must be returned with the claim form if you are making your claim by post. This will assist our staff in confirming that the correct fee

More information

Tamworth Borough Council Housing Application Form

Tamworth Borough Council Housing Application Form Tamworth Borough Council Housing Application Form Please read this form carefully and complete all sections. An incomplete form will be returned to you for completion. The information you give us will

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

Housing Register Application Form

Housing Register Application Form Housing Register Application Form creating communities to be proud of Housing Register Application Form Page About Us...1 Section 1: You and Your Household...2 Section 2: Your Eligibility...4 Section 3:

More information

HB1- HOUSING BENEFIT CLAIM FORM FOR NEW CLAIMS

HB1- HOUSING BENEFIT CLAIM FORM FOR NEW CLAIMS HB1- HOUSING BENEFIT CLAIM FORM FOR NEW CLAIMS Do not use this form if you currently receive Housing Benefit and are moving home ask for a Change of Address form instead. Complete all the sections that

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