Your Benefit Reference Number: About your partner (in the case of couples)
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1 Housing Benefit And Council Tax Reduction Self-Employed Earnings Information PART ONE You have told us on your claim form you or your partner is self-employed. We need more information about your or your partner s earnings so we can make a decision about your claim. You must complete this form promptly and sign the declaration on page 6. If you have just started a new business within the last 13 weeks please complete part 1 with the weeks you have been in business for and then complete part 2 (page 7) with an estimation of what you will earn in the next 13 weeks. Please ensure that you sign both declarations. Your Benefit Reference Number: Section 1- About you Your name and address Date issued: About your partner (in the case of couples) Your partner s name Section 2 Company directors Are you or your partner a director of a company or business? You Yes No Your partner Yes No If you or your partner ticked No, go to Section 3 of this form. If you or your partner ticked Yes you only need to complete this section and then sign the declaration in Section 11, as you are not classed as self-employed. Company directors only: Company directors are not self-employed under Housing Benefit/Council Tax Reduction rules. Please provide your last 5 weeks/2 months/3 fortnightly payslips, and confirmation from a company official of all income and payments you are receiving from this business. Do you receive any share or dividend income from the company if it is Yes listed? What is the value of your share dividend per annum? No What is the capital value of the company? Version 2 February 2014
2 Section 3 About the profit and loss accounts Do you have any profit and loss accounts prepared by an accountant (audited or otherwise) for the last trading year? Yes No If Yes, then you only need to provide these accounts. This form does not need to be completed unless we asked for information for a different period. If No, please fully complete, sign and return this form. Section 4 Who is self employed Who is self-employed? You Your partner Both Another household member please give their name. They are the person required to complete and sign this form. If you ticked the box Both ask us for another one of these forms for your partner. Section 5 About the self-employed business Name of business Business address including postcode What type of self-employed business is this? Date business started (if this is less than 13 weeks ago, please also provide estimated trading figures in PART TWO of this form). / / Please confirm below the period you are giving us details for. This should normally be the last full financial year from 6 th of April one year to 5 th of April the next, or if you recently started trading, then from the start of your business to date. A - Start date of period / / to B End date of period / / What is the average number of hours you work per week? Are you a sole trader? Yes No per week What is the total gross profit for your trading period A to B above. This is your total income before s Version 2 February 2014
3 Please list any Government funding below: New Enterprise Allowance Other Government funding, please indicate Is your business a partnership? Yes No If No go to Section 6. If Yes - how many other business partners are there? what percentage of the total gross profit above is yours? % If you are a member of a couple, is your actual partner an associate in the business? If Yes what percentage of the profit/loss is theirs? % Yes No Section 6 Home partly used for business Do you use part of your own home for business purposes? Yes No If No go to Section 7. If Yes give details below: How many rooms in total are there in your home? Which room (or rooms) do you use for business purposes? Is the room (or rooms) used only part of the time for business use? Yes No If No go to Section 7. If Yes give details below: What percentage of the time is for business purposes? % Version 2 February 2014
4 Section 7 Business s If you are a self-employed childminder do not fill in this section, go to Section 10. Please list all your self-employed business related s. Please specify what percentage of any is for personal use. For example, if you include telephone calls as an, you must tell us the percentage of the total cost in column B) that is for personal or private use. If you told us earlier you are in a business partnership, please tell us the total business s. If there is no part of the s below that is personal use write 0% in column C). Please give the amount of for the period you have stated on section 4. If you have a yearly please note this against the amount declared. PLEASE NOTE: Not all s declared on this form can be used in the calculation of your Housing Benefit and/or Council Tax Reduction. B) Amount of A) Type of Accountancy fees Admin charges Advertising Bank charges Building costs Building maintenance Business entertainment Business rates (NNDR) Capital allowances Capital on loans for repairs or replacements Charges to convert foreign currency to Cleaning of business premises or equipment Debt recovery costs Delivery charges Depreciation Expansion costs Hire or leasing charges Insurance for business liabilities/assets Interest on loans for repairs or replacements Legal fees Losses incurred before the trading period Losses from any other business offset Membership fees for professional bodies Postage and printing Proven bad debts Replacement costs for insured equipment or machinery Replacement costs for uninsured equipment or machinery Rent wholly and exclusively business use Security for business premises Set up costs Special clothing e.g. overalls and uniforms Subcontractor fee 20% or 30% for builders on CIS Subscription fees for professional bodies Subsistence Sundries Stock purchases Telephone broadband charges Tips Transport/travel costs C) % of personal Version 2 February 2014
5 VAT paid to HMRC (excluding refunds) Vehicle s (give details below) Who owns the vehicle(s)? SELF/BUSINESS Is/are the vehicles(s) used solely for business? Yes No If Yes do your own vehicle for personal use? Yes No If No what proportion of the total mileage is business use? % Road Tax Fuel - Petrol/Diesel Repairs and Maintenance B) Amount of A) Type of Wages for employees other than yourself Other s not listed overleaf (tell us which) C) % of personal Section 8 National Insurance Are you exempt from paying Class 2 National Insurance Contributions? Yes No If No go to Section 9. If Yes please provide your Certificate of Small Earnings Exception. Section 9 Personal pension scheme Contributions over trading assessment period to a personal pension scheme Or annual payment for personal pension scheme You must provide proof of the scheme to which you belong and of the payments made Version 2 February 2014
6 Section 10 Looking forward To help us decide when we next need to review your self-employed income, please indicate below when you expect have your profit and loss figures available for the next full financial year? / (MM/YYYY) Do you expect these profit and loss figures to be prepared by an accountant? Yes No Section 11 DECLARATION Please read this declaration carefully before you sign and date it. I understand the following. If I give information that is incorrect or incomplete, you may take action against me. This may include court action. You will use the information I have provided to process my claim for Housing Benefit and/or Council Tax Reduction. You may check some of the information with other sources as allowed by law. You may use any information I have provided in connection with this and any other claim for Social Security/Her Majesty s Revenue and Customs Benefits that I have made or may make. You may give some information to other organisations such as government departments, local authorities and private sector companies such as banks and organisations that may lend me money, if the law allows this. I know I must let the council know about any changes in my circumstances, which might affect my claim. I declare the information I have given on this form is correct and complete. If you are the claimant and self-employed you must sign this declaration. If your partner only is self-employed you must both sign this declaration. If you are both self-employed we need two of these forms completed and signed by both of you. Signature of selfemployed person Date Please return this form to:- Revenues & Benefits Service, PO Box 238, Stanley, Co Durham, DH8 1FP You must return this form promptly, and no later than one month from the date you were first asked to provide details of self-employed income. Failure to return this form within the given deadline may result in you receiving no Housing Benefit and/or Council Tax Reduction, or in any existing claims being cancelled Version 2 February 2014
7 PART TWO Self-employed earnings estimate declaration If you have started self-employment in the last 13 weeks please use this sheet to give us a detailed estimate of your income and s for the next 13 weeks. Section 1- About you Your name and address About your partner (in the case of couples) Your partner s name Section 2 Who is self employed Who is self-employed? You Your partner Both Another household member please give their name. They are the person required to complete and sign this form. If you ticked the box Both ask us for another one of these forms for your partner. Section 3 About the self-employed business Name of business Business address including postcode What type of self-employed business is this? What is the estimated gross profit for the next 13 weeks. This is your total expected income before s. Please list any Government funding below. Type of funding Is your business a partnership? Yes No Version 2 February 2014
8 If No go to Section 5. If Yes answer the following questions: How many other business partners are there? What percentage of the estimated gross profit above is yours? % If you are a member of a couple, is your actual partner an Yes No associate in the business? If Yes what percentage of the estimated profit/loss is theirs? % Section 4 Estimated business s Please list all your self-employed business related s. Please specify what percentage of any is for personal use. For example, if you include telephone calls as an, you must tell us the percentage of the total cost in column B) that is for personal or private use. If you told us earlier you are in a business partnership, please tell us the total business s. If there is no part of the s below that is personal use write 0% in column C). If you have a yearly please note this against the amount declared. PLEASE NOTE: Not all s declared on this form overleaf can be used in the calculation of your Housing Benefit and/or Council Tax Reduction. B) Amount of A) Type of Accountancy fees Admin charges Advertising Bank charges Building costs Building maintenance Business entertainment Business rates (NNDR) Capital allowances Capital on loans for repairs or replacements Charges to convert foreign currency to Cleaning of business premises or equipment Debt recovery costs Delivery charges Depreciation Expansion costs Hire or leasing charges Insurance for business liabilities/assets Interest on loans for repairs or replacements Legal fees Losses incurred before the trading period Losses from any other business offset Membership fees for professional bodies Postage and printing Proven bad debts Replacement costs for insured equipment or machinery Replacement costs for uninsured equipment or machinery Rent wholly and exclusively business use Security for business premises C) % of personal Version 2 February 2014
9 Set up costs Special clothing e.g. overalls and uniforms Subcontractor fee 20% or 30% for builders on CIS Subscription fees for professional bodies Subsistence Sundries Stock purchases Telephone broadband charges Tips Transport/travel costs VAT paid to HMRC (excluding refunds) Vehicle s (give details below) Who owns the vehicle(s)? SELF/BUSINESS Is/are the vehicles(s) used solely for business? Yes No If Yes do your own vehicle for personal use? Yes No If No what proportion of the total mileage is business use? % Road Tax Fuel - Petrol/Diesel Repairs and Maintenance B) Amount of A) Type of Wages for employees other than yourself Other s not listed overleaf (tell us which) C) % of personal Version 2 February 2014
10 Section 5 DECLARATION Please read this declaration carefully before you sign and date it. I understand the following. If I give information that is incorrect or incomplete, you may take action against me. This may include court action. You will use the information I have provided to process my claim for Housing Benefit and/or Council Tax Reduction. You may check some of the information with other sources as allowed by law. You may use any information I have provided in connection with this and any other claim for Social Security/Her Majesty s Revenue and Customs Benefits that I have made or may make. You may give some information to other organisations such as government departments, local authorities and private sector companies such as banks and organisations that may lend me money, if the law allows this. I know I must let the council know about any changes in my circumstances, which might affect my claim. I declare the information I have given on this form is correct and complete. If you are the claimant and self-employed you must sign this declaration. If your partner only is selfemployed you must both sign this declaration. If you are both self-employed we need two of these forms completed and signed by both of you. Signature of selfemployed person Date Please return this form to:- Revenues & Benefits Service, PO Box 238, Stanley, Co Durham, DH8 1FP You must return this form promptly, and no later than one month from the date you were first asked to provide details of self-employed income. Failure to return this form within the given deadline may result in you receiving no Housing Benefit and/or Council Tax Reduction, or in any existing claims being cancelled Version 2 February 2014
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