Budgeting Loans from the Socia Fund tes sheet Pease read these notes carefuy. They expain the circumstances when a budgeting oan can be paid. Budgeting Loans You may be abe to get a Budgeting Loan if: you have been getting Income Support, income-based Jobseeker s Aowance, income-reated Empoyment and Support Aowance, Pension Credit or payment on account of one of these benefits or entitements for at east 26 weeks on the date we process your appication. and You need hep to buy furniture or househod equipment to buy cothing and footwear to pay rent in advance and/or remova expenses to secure fresh accommodation to pay for home improvements, maintenance or security with traveing, maternity and funera expenses to pay for things to hep you ook for or start work to repay HP or other debts that have been taken out. We cannot hep with any other types of items or services. Budgeting Loans have to be paid back but they are interest free. You can have one of three rates of Budgeting Loan. The amount depends on whether you are singe, a coupe without chidren or quaifying young persons, or a one or two parent famiy with chidren or quaifying young persons. For a singe person the maximum rate is 348, for a coupe without chidren or quaifying young persons the maximum rate is 464, and for one or two parent famiies with chidren the maximum rate is 812. We cannot pay you more than these amounts. The amount of Budgeting Loan you can have aso depends on whether you sti have any other Budgeting Loans or Crisis Loans you haven t paid back to the Socia Fund. We cannot make a payment for a oan if you aready owe 1,500 or more to the Socia Fund for any previous Crisis Loans or Budgeting Loans combined. Pease turn over for more information t
tes Savings If you and your partner are aged under 62, savings of more than 1,000 may affect the amount of money you can get. If you or your partner are aged 62 or over, savings of more than 2,000 may affect the amount of money you can get. We cannot make a payment for a oan if you aready owe 1,500 or more to the Socia Fund. We cannot pay a Budgeting Loan for expenses of ess than 100. How we decide what we can pay you The decision maker wi ook at the reevant circumstances and decide the maximum size of Budgeting Loan you can have, if you have no existing Socia Fund debt. Whether or not you can have a oan of up to that amount wi depend on if you aready have a budgeting oan debt. How you pay back a oan We wi ook at what you can afford before we decide on the arrangements for repayments. If we can pay you a Budgeting Loan, we may make you up to three different offers. It wi be up to you which of these offers you can afford to pay back. We may not be abe to ower the repayment rate if you ater fee you cannot afford the rate you originay agree to. If we can pay you a Budgeting Loan, we wi ask you to agree to repay it and aso to agree the way you wi repay it before we make the payment. We wi take the money back in weeky repayments from your benefit. If you or your partner do not get any benefit, we wi arrange for the oan to be repaid in another way. If you have probems ater on making the repayments as originay agreed, we may be abe to hep, for exampe reducing your payments by extending the repayment period. Your Jobcentre Pus office can give you advice. Hep and advice If you want more information get in touch with Jobcentre Pus. Phone 0345 603 6967. You can aso ca 0845 603 6967. Check with your phone company which code is cheaper for you. You can aso get more information from www.gov.uk or get in touch with an advice centre ike the Citizens Advice Bureau. We use partner to mean a person you ive with who is your husband, wife or civi partner, or a person you ive with as if you are a married coupe. We use chid to mean a person aged under 16 who is iving with you and you are getting Chid Benefit for. We use quaifying young person to mean a person aged 16, 17, 18 or 19 who is iving with you, who you are getting Chid Benefit for. These notes give genera guidance ony and shoud not be treated as a compete and authoritative statement of the aw. Tear off this page to keep for your information s
Part 1: About you and your partner Before you compete this form, pease read the notes sheet which tes you about a types of hep you can get from the Socia Fund. Use this form to appy for a Budgeting Loan. Sign and date any aterations you make. If you are getting Income Support, income-based Jobseeker s Aowance, income-reated Empoyment and Support Aowance or Pension Credit, the person who both caims and gets paid that benefit or entitement shoud fi in this form. Te us about yoursef and your partner, if you have one. We use partner to mean a person you are married to or a person you ive with as if you are married to them, or a civi partner or a person you ive with as if you are civi partners. Fi in the form fuy by answering a the questions and requests for information. Your appication may be deayed if we do not have a the information we need. Pease fi in this form with BLACK INK and in CAPITALS. For office use ony Date of SFCS input Appication number Initias Date decision made Signature You Your partner Letters Numbers Letter Letters Numbers Letter Nationa Insurance (NI) number You can find the number on a Nationa Insurance (NI) numbercard, etters about benefit, or paysips. Surname or famiy name Mr / Mrs / Miss / Ms Mr / Mrs / Miss / Ms Any other surnames or famiy names you have been known by A other names, in fu Date of birth Daytime phone number We may need to contact you by teephone to ask you for further information, or when a decision on your appication is made. Pease note that the number may dispay as a 0800, unknown or withed number. 1
Part 1: About you and your partner continued You Your partner Mobie phone number, if you have one Your emai address, if you have one Address where you ive now Pease te us your current address, and te us your partner s current address, if it is different. Postcode Postcode Date you or your partner moved into this address Te us if this address is temporary. temporary. permanent. permanent. Previous address Pease te us your previous address, and te us your partner s previous address, if it is different. Postcode Postcode Are you or your partner invoved in a trade dispute? We use trade dispute to mean a strike, wak-out, ock-out or any other dispute about work. 2
Part 2: About your chidren or quaifying young persons Pease te us about any chidren or quaifying young persons you are getting a benefit or entitement for. Name We use chid to mean a person aged under 16 who you are getting Chid Benefit for. We use quaifying young person to mean a person aged 16, 17, 18 or 19 who you are getting Chid Benefit for. Date of birth Name Date of birth Are you getting Income Support or income-based Jobseeker s Aowance for your chidren or quaifying young persons? Are you getting Chid Tax Credit for your chidren or quaifying young persons? Are you getting Chid Benefit for your chidren or quaifying young persons? How much do you get a week? How much do you get a week? How much do you get a week? Part 3: About what you need Budgeting oans can ony be given for the types of items or services isted in this part. Pease enter the tota amount you need in the Tota amount appied for box for what you need. Aso tick the other category boxes that appy to you. We do not need any more information for this part. Pease refer to the notes sheets for the maximum rates of Budgeting Loans depending on your circumstances. Tota amount appied for Furniture and househod equipment Cothing and footwear Rent in advance or remova expenses to secure fresh accommodation Expenses associated with seeking or re-entering work Maternity expenses Funera expenses Improvement, maintenance and security of the home Repaying HP and other debts for any Traveing expenses within the UK items or expenses which are associated with the categories above 3
Part 4: About benefits and entitements Are you or your partner currenty getting Income Support, income-based Jobseeker s Aowance, income-reated Empoyment and Support Aowance, Pension Credit or payment on account of one of these benefits or entitements? Go to Part 8. Te us which benefits or entitements you are getting and the dates you have been getting them in the ast 26 weeks. Income Support Jobseeker s Aowance (income-based) Empoyment and Support Aowance (income reated) From to From to From to Pension Credit From to Has a partner or an ex-partner received Income Support, income-based Jobseeker s Aowance, income-reated Empoyment and Support Aowance, Pension Credit or payment on account of one of these benefits or entitements for you, in the ast 26 weeks? Te us about this person: Their name Date of birth Their Nationa Insurance (NI) number Date of separation Their address Postcode Have you made this caim because you have separated from someone? Te us about the person you have separated from: Their name Date of birth 4
Part 5: About money you have to pay out Pease te us about any money that you or your partner have to pay out reguary, but do not incude norma iving expenses ike gas and eectric charges or food bis. Incude things ike cataogue money, hire purchase, oan payments and fines. Pease answer a the questions for each reguar payment. If you do not give us a the information, we wi not be abe to decide this caim. Payment 1 Who do you pay the money to? How much are you paying and how often? every week every fortnight every month How much is aready owed? Payment 2 Who do you pay the money to? payment deducted from my benefit How much are you paying and how often? every week every fortnight every month How much is aready owed? Payment 3 Who do you pay the money to? payment deducted from my benefit How much are you paying and how often? every week every fortnight every month How much is aready owed? Payment 4 Who do you pay the money to? payment deducted from my benefit How much are you paying and how often? every week every fortnight every month How much is aready owed? payment deducted from my benefit 5
Part 6: About your savings If you do not compete this part of the form your appication may be deayed Do you or your partner have any savings? If you and your partner are both aged under 62, we may be abe to disregard the first 1,000 of your savings. If either you or your partner are over 62, we may be abe to disregard the first 2,000 of your savings. Savings means any capita you and your partner have, incuding any money you have at home, in the bank, in the buiding society or in a credit union account premium bonds investments, such as shares or unit trusts. the vaue of any property you or your partner own that you do not ive in. For exampe, a house you et out, a hoiday home, or somewhere another member of your famiy ives. How much savings do you have? 6
Part 7: How we pay you If you to use the account you usuay get your benefits paid into, pease go straight to part 8 We normay pay your money directy into the same account as we pay your benefit into. Many banks and buiding societies wi et you coect your money at the post office. We wi te you when your Socia Fund payment wi be made and how much it wi be for. Finding out how much we have paid into the account You can check your payments on account statements. The statements may show your Nationa Insurance (NI) number next to any payments we have made. If you think a payment is wrong, get in touch with the office that pays you straight away. If we pay you too much money If we pay you too much money we have the right to take back any money we pay that you are not entited to. This may be because of the way the system works for payments into an account. For exampe, you may give us some information which means you are entited to ess money. Sometimes we may not be abe to change the amount we have aready paid you. This means we wi have paid you money that you are not entited to. We wi contact you before we take back any money. What to do now Go to Part 8, uness you want us to pay your Socia Fund payment into a different account to the one we pay your benefit into. If you want us to pay your Socia Fund payment into a different account, te us about this on the next page. By giving us these account detais you agree that we wi pay you into this account, and understand what we have tod you above in the section If we pay you too much money. If you are going to open an account, pease te us your account detais as soon as you get them. If you do not have an account, and do not intend to open one, pease tick this box and we wi contact you. Fi in the rest of this form. You do not have to wait unti you have opened an account or contacted us. 7
Part 7: How we pay you continued If you wish to use a different account, pease te us about the account you wish to use for this payment You can use an account in your name, or a joint account. You can use someone ese s account if the terms and conditions of their account aow this, and they agree to et you use their account, and you are sure they wi use your money in the way you te them. You can use a credit union account. You must te us the credit union s account detais. Your credit union wi be abe to hep you with this. If you are an appointee or a ega representative acting on behaf of the caimant, the account shoud be in your name ony. Pease te us your account detais beow. It is very important you fi in a the boxes correcty, incuding the buiding society ro or reference number, if you have one. If you te us the wrong account detais your payment may be deayed or you may ose money. You can find the account detais on your chequebook or bank statements. If you do not know the account detais, ask the bank or buiding society. Name of the account hoder Pease write the name of the account hoder exacty as it is shown on the chequebook or statement. Fu name of bank or buiding society Sort code Pease te us a 6 numbers, for exampe: 12-34-56. Account number Most account numbers are 8 numbers ong. If your account number has fewer than 10 numbers, pease fi in the numbers from the eft. Buiding society ro or reference number If you are using a buiding society account you may need to te us a ro or reference number. This may be made up of etters and numbers, and may be up to 18 characters ong. If you are not sure if the account has a ro or reference number, ask the buiding society. You may get other benefits and entitements we do not pay into an account. If you want us to pay them into the above account, pease tick this box. 8
Part 8: For peope fiing and signing this form for someone ese Have you fied this form in for someone ese? Pease te us why you are fiing in and signing this form for someone ese. Go to Part 9. Pease te us about yoursef. I am sending a etter signed by the caimant with this form. The etter tes you that they agree to me making the caim for them. w sign this form in Part 9. I am their appointee. I have power of attorney. Your fu name Your date of birth Your address Your phone number Code Number Postcode What is this number? Pease tick Home Work Mobie Fax w sign this form in Part 9. 9
Part 9: Decaration I decare that the information I have given on this form is correct and compete as far as I know and beieve. I understand that if I knowingy give information that is incorrect or incompete, my benefit may be stopped and I may be iabe to prosecution or other action. I understand that I must prompty te the office that pays my benefit of anything that may affect my entitement to, or the amount of, any award. This is my appication for a Budgeting Loan. The person who made the caim for Income Support, income-based Jobseeker s Aowance, income-reated Empoyment and Support Aowance or Pension Credit and who gets paid that benefit or entitement shoud sign and date this form. Benefit recipient signature or appointee signature Date I have read back to the customer the entries I made on this form based on the information given by them. The customer has agreed they are correct. Interviewing officer s signature Customer s signature Date Date Part 10: What to do now Look through this form and check you have answered a the questions and given a the information requested. Your appication may be deayed if we do not have a the information we need. If you have made any aterations, pease make sure you initia and date them. Check you have signed the form at Part 9. 10
Part 11: Where to send this form When you have fied in the appication form, send it to us in the enveope we have sent you or take it to your nearest Jobcentre Pus office. You can find the address in the business section of the phone book. Look under Jobcentre Pus. Part 12: What happens next Your appication wi be ooked at carefuy. The decision maker has to ook at the reevant circumstances before deciding if a Budgeting Loan can be awarded. There is ony a imited amount of money avaiabe from the Socia Fund. If we decide we can pay you a oan, and you agree the terms for repaying the oan, we wi make a payment to the same account as your benefit is paid into, uness you have given us detais of a different account in Part 7. If we cannot pay you a oan, we wi et you know. Part 13: How the Department for Work and Pensions coects and uses information When we coect information about you we may use it for any of our purposes. These incude deaing with: socia security benefits and aowances chid support empoyment and training financia panning for retirement occupationa and persona pension schemes. We may get information about you from others for any of our purposes if the aw aows us to do so. We may aso share information with certain other organisations if the aw aows us to. To find out more about how we use information, visit our website at www.gov.uk/dwp/persona-information-charter or contact any of our offices. Part 14: Our service standards At Jobcentre Pus we aim to provide a high standard of customer service at a times. Detais of the standard of service you can expect from us can be found at www.gov.uk You can access our website from many ibraries. For more information pease contact Jobcentre Pus. 11
This page is for officia use ony Use this page to record any further information, notes of interviews, changes of circumstances and so on. Date Caimant s name NI number 12