Gloucester City Council Name Flat/Room New Address you wish to claim for Date Issued HB Ref Form HBCTB-SE Postcode Housing and Council Tax Benefit: Additional form for Self-employed earnings It is very important that you read the instructions carefully and provide all the original evidence needed to claim benefit Please fill in this form as an addition to the main Housing/Council Tax benefit application form. You are self-employed if you pay Class 2 National Insurance contributions and are responsible for paying your own income tax. If you do not fill in this form correctly or completely, it will take longer to deal with your claim. You will need to send us various original documents as proof of your income and expenditure. Benefit will not be paid if you fail to supply all the supporting evidence. The Benefits Service will respond within 14 days of receiving this form. You must complete this form in black ink and answer each section fully. Do not complete this form in pencil, blue ink or felt-tip pen. (This is for the benefit of our Document Management System as all your documents are scanned onto a computer and black makes them easier to read.) Useful telephone numbers: Housing and Council Tax Benefit Advice Line 01452 396483 benefits@gloucester.gov.uk Benefit Fraud Hotline 0800 731 7111 beat.benefitfraud@gloucester.gov.uk Council Tax Advice Line 01452 396495 revenues@gloucester.gov.uk Housing Advice Service 01452 396504 housing@gloucester.gov.uk Homelessness Service 01452 396567 housing@gloucester.gov.uk Customer Services Appointments 01452 396407 Revenues@gloucester.gov.uk Minicom: 01452 396161 January 2007 Gloucester City Council Benefits Service Herbert Warehouse The Docks Gloucester GL1 2EQ Email: benefits@gloucester.gov.uk Opening hours: 8.45am to 5.00pm Monday to Friday
SECTION A: About your Business Important te: Please complete this section in full and provide original documentary evidence where required. Please answer every question Name of your business: Full address of your business: Business Tel..: Type/Nature of business: Date business commenced: / / Start date of current financial year: / / Average number of hours worked per week: Is your businesss a partnership? If YES, what percentage of the profit/loss is yours? (Provide your partnership agreement) % Is husband/wife a partner in the business? If YES, what percentage of the profit/loss is theirs? % Is husband/wife on the payroll of the business? If YES, what are his/her weekly earnings? Are there any other people on the payroll of the business? Do you use part of your home for business purposes? If YES, provide details: Page 1
Section B: About the Business income Do you have any prepared accounts (audited) for the last financial year? If YES, return an original set of the accounts with this form. If NO, please state the reason why you do not have accounts and when you expect to have them. Do you have your latest Schedule D Tax Assessment? If YES, please return it with this form. If NO, please state the reason why not and when you expect to have the form. Income: It is important that you provide a breakdown of your income for the last financial year or for the period that you have been trading. If you have not been trading, but are about to commence self-employment provide a breakdown of your projected income for the next 3 months. Actual Income From To From Sales / Takings / Income Plus V.A.T. refunded Plus enterprise allowance Plus closing stock Less cost of sales Less opening stock Gross profit Projected Income To Page 2
SECTION C: About the Business expenditure Important te: It is important that you provide a breakdown of your expenditure for the last financial year or for the period that you have been trading. If you have not been trading, but are about to commence self-employment provide a breakdown of your projected expenditure for the next 3 months. Expenditure: You must only include amounts that relate solely to the business. E.g. if telephone calls are made you must apportion the total cost in accordance with the amount of private use and enter the amount for business use only. Drawings (Cash or stock) (These may be your wages or salary paid to yourself from the business) Actual Expenditure From To From Projected Expenditure To Wages paid out: To employees Wages paid out: To spouse Wages paid out: To others Rent Business rates Heating and lighting Cleaning Telephone Fax Business Insurance Advertising Printing and stationery Postage Accountants charge Bank charges Page 3
Interest payment on Business loans (Enclose a copy of the loan agreement) Repairs/replacement of a business asset (Do not include motoring) Was this covered by insurance? Leasing charges (Please specify) Business entertainment Bad Debts (Please specify) Other expenses (Please specify) Motoring Expenses: Vehicle lease Road tax Petrol/diesel Insurance Repairs Who owns the vehicle(s)? Self Business What proportion is this vehicle used for private use? % Page 4
SECTION D: About the Business outgoings National Insurance Do you hold an exemption certificate? If YES, please provide the original certificate. If NO, please provide evidence of your contributions and confirm whether you pay them weekly/monthly/annually. (Please delete where appropriate and provide evidence) every Personal Pension Contributions Do you contribute to a personal pension scheme? If YES, confirm how much you pay weekly/monthly/annually. (Please delete where appropriate and provide original evidence) every Further information: Please use the box below to give any further information you feel may be important to your Housing/Council Tax Important te: Remember to send us your prepared accounts and any other evidence that is relevant to your selfemployed business. If you do not have any accounts send us your original account books, receipts and invoices. Please return this form to us as soon as possible. Any delays in returning this form may result in a delay in paying you benefit or a loss of benefit entitlement. Page 5
SECTION E: Declaration Warning: You may be prosecuted if you give false or incorrect information or fail to notify any changes of circumstances. 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. You will use the information I have provided to process my claim for Housing Benefit and/or Council Tax Benefit, or both. You may check some of the information with other sources within the council, rent offices, and local authorities. You will use the information I have provided in connection with this and any other claim for Social Security benefits that I have made or may make. You may give some information to other government organisations, 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. Signature of person claiming Date / / Page 6
Useful Addresses and Phone Numbers If you prefer, you can ask for independent help. Please contact any of the following agencies: Citizens Advice Bureau 75-81 Eastgate Street Tel: 01452 528017 Open Mon, Wed, Thurs & Fri 9.30-4.30, Tues 1.00-6.00 Gloucester Law Centre 75-81 Eastgate Street Tel: 01452 423492 (Please ring for an appointment. In emergencies drop in Mon & Thurs 10.00-12.00 / Tues 1.30-3.00 White City Project 110 Finlay Road Tel: 01452 423881 Open Mon, Tues, Thurs, Fri 9.30-12.00. Wed - Starvaell Centre, Finlay Road 10.30-12.30 Tel: 01452 554412 Matson Neighbourhood Project Matson Resource Centre, Matson Lane Tel: 01452 505544 Open Mon - Thurs 9.00-4.30, Fri 9.00-4.00 The One Stop Shop Matson Neighbourhood Project, Matson Avenue Tel: 01452 526014 Open Mon - Fri, 9.15-12.30 Coney Hill Neighbourhood Project 1A Stanway Road Tel: 01452 380116 Open Mon - Fri, 9.30-4.00 Podsmead Neighbourhood Project 96-98 Masefield Avenue Tel:01452 541576 Open Mon - Thurs, 9.30-4.00, Fri 9.30-1.00 GLOFYSH 4 Wellington Street Tel: 01452 81650 Open mon, Wed, Fri 11.00-1.00. Tues appointment only, 10.00-1.00 Thurs appointment only,12.00-1.00 Department for Work and Pensions Cedar House, Spa Road Tel: 01452 366000 Gloucester Job Centre 37-41 Southgate Street Tel: 01452 365100 Tax Credits Helpline Tel: 0845 300 3900 Pension Credit Application Line (freephone) Tel: 0800 99 1234 Pension Credit Enquiries Tel: 0845 60 60 265 This is an application form for Housing and or Council Tax Benefit. If you wish to have a copy in Bengali, gujarati or Urdu, please fill in your name and address below: Please send me a Benefit Application Form in Bengali Chinese Gujarati Urdu Name: Address Telephone : Page 7