Application for Housing Benefit and Council Tax Reduction

Application for Housing Benefit and Council Tax Reduction tes for filling in the Housing Benefit and Council Tax Reduction claim form About this form The Housing Benefit and Council Tax Reduction claim form has been designed to be easy to fill in. It may look rather long, but we have to ask a lot of questions to make sure that everyone who claims gets the right amount of benefit. You may not have to fill in all the parts of the form, but you must fill in any part that is relevant to you, your spouse, your partner or any other household members. Every part starts with a question to help decide if you need to fill in that part. Second Adult Rebate Second Adult Rebate is Council Tax Reduction for people who may not have a partner but who share their home with someone who: is 18 or over; and is on a low income; and does not pay them rent. If you are claiming Second Adult Rebate, only fill in Part 1, Part 3 and Part 17 of this form. However, if you are not sure which benefit you may be entitled to, or are better off claiming, then complete the whole form and we will work out which type of benefit results in you receiving the most benefit. Evidence We need to see evidence of some of the things you tell us about. There is a checklist at the end of the form to help you. If you are not sure if we need to see evidence of something, get in touch with us. We will tell you what we need to see. We cannot pay you benefit until we have seen the evidence we have asked for. Filling in the form If you are filling in this form by hand, use ink. 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. Answer or questions by putting a tick in the relevant box. If you are picking an answer from a list of answers, put a tick in the relevant box. Do not put a cross in any boxes. If someone else fills in the form for you, there is a special space for them to sign. If you need help filling in this form, please contact your local Benefits office. Contact details for your local office are included in your claim pack.

What to do next When you have filled in the form, sign it and take it to your local benefits office, with the evidence we need to see. Do not post valuable items such as benefit order books, bank books or passports. Bring them to the local office and we will get the information we need and give them back to you. If you cannot get the evidence we need straight away, do not worry. You must hand in your form immediately. We will tell you what evidence is required. If you do not bring the form to us straight away, you will lose money. When we usually pay benefit from We will usually pay your benefit from the Monday after we get your form. Changes you must tell us about Tell us straight away if: any of your children leave school or leave home; anyone moves into or out of your home (including lodgers and subtenants); your income or the income of anyone living with you, including benefits, changes; your capital, savings or investments change; you or anyone living with you becomes a student, goes on a Youth Training Scheme, goes into hospital or a nursing home, goes into prison, or gets, changes or leaves a job; you are a private sector tenant and your rent changes; you move; you or your partner are going to be away from home for more than a month; you receive any decision from the Home Office; or anything you have told us changes. You must tell us about these changes in writing a phone call is not enough. If you don t tell us about these changes you may lose money you are entitled to or you may get too much benefit. You must make sure that you tell us about these changes. Don t rely on someone else to pass the message on. It is an offence not to tell us about any change of circumstance that affects your benefit. We may take court action against you and if we pay you too much benefit, you will probably have to pay it back. How we collect and use information We will use the information you give in this form, and in any supporting evidence provided, to process your claim for Housing Benefit and Council Tax Reduction. We may pass the information to other agencies or organisations such as the Department for Work and Pensions and Her Majesty s Revenues and Customs, as allowed by law. South Ayrshire Council may use the information contained in this form to see if you are entitled to school clothing grants and improvement/repairs grants or any other benefits. We may check information you have provided, or information about you that someone else has provided, with other information held by us. We may also get information about you from certain third parties, or give them information to: make sure the information is accurate; prevent or detect crime; and protect public funds. These third parties include government departments and local authorities. We will not give information about you to anyone else, or use information about you for other purposes, unless the law allows us to. Remember it is an offence to give false information under the Social Security Administration (Fraud) Act 1997 and you may be prosecuted.

Claim Reference Date of issue Date received Date of first contact A claim form for Housing Benefit and Council Tax Reduction Are you (please tick one box) a council tenant? a private tenant? a housing association or social landlord tenant? a a home owner? living with your parents or relatives? living in board and lodgings? Part 1 About you and your partner Do you have a partner who normally lives with you? Surname or family name First and middle names Any other names you have used Title (Mr, Mrs, Ms, other) Address Do not tell us your partner s address if it is the same as yours. If you have a partner, you must answer all the questions about them, as well as yourself. You Your partner Your daytime telephone number Code Number Code Number What is this number? Please tick Home Mobile Work Textphone Home Mobile Work Textphone Date of birth Letters Numbers Letter Letters Numbers Letter National Insurance (NI) number You can find this on payslips or letters from the Department for Work and Pensions or the tax office. We cannot If you do not have a National If you do not have a National normally decide your claim if we do Insurance number, or cannot find it, Insurance number, or cannot find it, not have your NI number. We need tick this box. tick this box. to see proof of this. We need to see proof of your identity and NI number. See the checklist at Part 15. If you want someone to act for you please write their name, address and telephone number in the area below Name Address Telephone Number Please note that your benefit decision letters will be issued to this person. 1

Part 1 About you and your partner - continued You Your partner Have you or your partner claimed Housing Benefit or Council Tax Reduction before? Please tell us about it below Please tell us about it below When did you last claim? Which council did you claim from? What name did you use for the claim? What address did you claim for? If you have moved from this address, have you told the council you claimed from? If you or your partner have moved home in the last 12 months, tell us your last address if it is different from above. Tell us whether you were the homeowner, a private tenant, a council tenant or a lodger at this address. Have you or your partner come to live in England, rthern Ireland, Scotland, Wales, the Republic of Ireland, the Channel Islands or the Isle of Man in the last two years? We will write to you about this We will write to you about this What is your nationality? If your nationality is not British, on what date did you last enter and apply to stay in the UK? The UK is England, rthern Ireland, Scotland and Wales. Are you or your partner in hospital at the moment? Please tell us about it below Please tell us about it below When did you go in? When will you come out, if you know this? 2

Part 1 About you and your partner - continued You Your partner Do you or your partner get Disability Living Allowance? Care Mobility Care Mobility Do you or your partner get Attendance Allowance? We will need to see proof of this We will need to see proof of this Does anyone get Carer s Allowance for looking after you or your partner? We will need to see proof of this We will need to see proof of this Have you or your partner been told that you are entitled to Carer s Allowance even if you do not receive it, because you are getting another benefit instead? We will need to see proof of this We will need to see proof of this Do you or your partner pay towards the upkeep of a student? Please state the student s name Please state the student s relationship to you Please state the student s date of birth How much do you pay and how often? every every Please provide evidence of your assessed contribution Please provide evidence of your assessed contribution Do you or your partner have a vehicle from a Mobility Scheme? We will need to see proof of this We will need to see proof of this Are you or your partner a student? By student we mean anyone who is attending a course of study at an educational establishment. Is this your final year of study? Tell us if this is full or part time Full time Part time We will need to see proof of this Tell us if this is full or part time Full time Part time We will need to see proof of this Please tick if you or your partner are: an apprentice on youth training in legal custody severely mentally impaired registered blind long-term sick or disabled an apprentice on youth training in legal custody severely mentally impaired registered blind long-term sick or disabled We will contact you if we need any more information. 3

Part 2 About Children We need to know about any children in your household for whom you receive child benefit i.e. children under 16, or aged 16, 17, 18 or 19 and in education doing a course not higher than GCE A-level, SCE Higher level or GNVQ (advanced). Are there any children in your household as described above? Go to Part 3 If there are more than three children, use a separate sheet of paper to tell us all the information we ask for on this page and send it with the form. If you are sending a separate sheet of paper, tick this box. First child Second child Third child Surname or family name First and middle names Date of birth What is the child s sex? The child s relationship to you? The child s relationship to your partner? Usual address, if different from yours Child Benefit number Who gets the Child Benefit for them? We need to see proof of this. Is the child registered blind? Does the child get Disability Living Allowance? We need to see proof of this We need to see proof of this We need to see proof of this Care Mobility Do you or your partner pay any childminding costs for this child to a registered childminder, a nursery or an after-school club? Tell us about it below Tell us about it below Tell us about it below Tell us the name and registration number of the childminder. How much do you pay a week? a week a week a week We need to see proof of this We need to see proof of this We need to see proof of this 4

Part 3 About other people who live with you w tell us about all the people who usually live with you and your partner. Do not tell us about people who just share a hall, bathroom or toilet with you. If you want to tell us about more than three people, use a separate sheet of paper. If you are sending a separate sheet of paper, tick this box. Do any adults usually live with you and your partner? By adults we mean people over 16 who nobody gets Child Go to Part 4 Fill in this section Benefit for. First person Second person Third person Surname or family name First and middle names Date of birth National Insurance (NI) number Their relationship to you or your partner Some examples are: aunt, brother, daughter, father, grandson, grandmother, stepdaughter, joint tenant, joint owner, subtenant, lodger, boarder or friend. Do they get Income Support, income-related Employment and Support Allowance, Pension Credit or income-based Jobseekers Allowance? Do they get Disability Living Allowance or Attendance Allowance? a week a week a week Are they registered blind? Are they a full-time student, a student nurse, a carer, an apprentice or on youth training? Tell us which Tell us which Tell us which Do they pay rent or money for board and lodgings to you or your partner? a week a week a week Are they severely mentally impaired? Are they in legal custody at the moment? When did they go in? When did they go in? When did they go in? When are they expected to come out? When are they expected to come out? When are they expected to come out? 5

Part 3 About other people who live with you - continued First person Second person Third person Are they in hospital at the moment? Please tell us about it below Please tell us about it below Please tell us about it below When did they go in? When are they due to come out (if you know)? Do they normally work for 16 hours or more a week? Do they have any other income at all? Make sure you tell us about all other income they have. Tell us their earnings before any deductions Tell us their earnings before any deductions Tell us their earnings before any deductions a week a week a week We need to see proof of their earnings Please tell us about it below We need to see proof of their earnings Please tell us about it below We need to see proof of their earnings Please tell us about it below This includes any benefits or allowances you have not told us about on this form and interest from savings and investments. 1. Where does this income come from? How much is it before deductions? 2. Where does this income come from? How much is it before deductions? 3. Where does this income come from? How much is it before deductions? We will need to see proof of their income We will need to see proof of their income We will need to see proof of their income If anyone living with you receives Income Support, income-based Jobseekers Allowance, income-related Employment and Support Allowance or Pension Credit they should sign this form to give the council their permission to verify these details. Each person should sign here : Are any of the people who normally live with you married to each other or living together as if they were married? We call these people partners. Please tell us their names below Is the partner of Is the partner of 6

Part 4 About rent Do you or your partner own your home or have a mortgage? Are you or your partner a council tenant? Do you or your partner pay rent for your home? Tick if you would pay rent but you already get Housing Benefit. What is your landlord s full name and business address? By landlord we mean the person or organisation who owns the property you live in. Go to Part 6 Go to Part 6 Go to Part 6 Tel. If your landlord has an agent, tell us their full name and address. By agent we mean the person or organisation you actually pay your rent to. Tel. Are you, your partner, or any of your or your partner s children related to your landlord or agent, or to your landlord s partner or the agent s partner? Who is the relative? Is my landlord s or agents Related includes related through marriage, even if the marriage has ended. Some examples are ex-wife, ex-husband, aunt, brother, daughter, father, grandson, grandmother, son-in-law or stepdaughter. Does your landlord live in the property you rent? When did you or your partner start renting your home? When did you or your partner move to this address? If you have not moved in yet, tell us when you expect to move in, then tell us when you have actually moved in. Has a family member, who lived with you at this address, died within the last 12 months? Name of family member Please give details below Relationship to you Date of death 7

Part 4 About rent - continued What sort of tenancy do you have? For example, shorthold, assured, tied rent. How long is the tenancy for? What is the property let as? Tick the box that applies Is your landlord responsible for decorating inside your home? Furnished Partly Furnished Hardly any furniture Unfurnished How much rent do you every pay and how often? For example, every week, every fortnight, every four weeks, monthly. to Have you paid any rent payments to your landlord? Does anyone else share the rent with you or you and your partner? If you are in arrears with your rent, your first payment may be paid to your landlord Send us proof of how much you have already paid, when the payments were made and how you ve made these payments. Tell us their name in the box below How many joint tenants are there? Date joint tenancy started If you share the rent, how much of the rent do every you pay and how often? For example, every week, every fortnight, every four weeks, monthly. Has your rent changed in the last 12 months? Send us proof of the date it changed and how much it changed When is the next rent increase due? Has your rent been registered as a fair rent by a rent officer? Do you have any weeks when you do not have to pay rent? Please send us the notice of registration form RO5. How many in a year? Are you behind with your rent? Who has to pay the Council Tax bill for your home? Tick the box that applies. By how many weeks? You or your partner Your landlord Someone else Tell us who it is. What is the Council Tax reference number? (This can be found on your bill) Does your rent include money for the following? Meals For which meals? Please tick every Breakfast Lunch Evening meal 8

Part 4 About rent - continued Heating every Lighting every Hot water every Fuel for cooking every Laundry every Cleaning rooms or windows every Gardening every Garage or parking space Personal care and support Do you pay any service charges separate from your rent, for example, for cleaning or lighting in shared areas, an alarm system, a warden, general counselling or support, meals, or lift maintenance? Do you have to rent the garage as part of your tenancy agreement? What for? every every every Are you or your partner living away from home at the moment? Why are you or your partner not living at home? When did you or your partner last live at home? When do you or your partner expect to go back home? What is the address of where you or your partner are living at the moment? Tell us about it below Have you sublet your home? Tell us about it below Who lives there now? We must see evidence of your rent and tenancy before we decide how much benefit you can get. Read the checklist at Part 15 to see what you can use as proof 9

Part 5 About where you live What sort of building do you live in? Tick one box only. Detached house Semi-detached house Terraced house Maisonette Flat over a shop Room (private use of a bedroom, sharing living room & kitchen & bathroom/toilet) Board and lodgings Caravan, mobile home or houseboat Hotel Bungalow Flat in a house Bedsit (private use of a bedsitting room, sharing kitchen & bathroom/toilet) Hostel Residential care home Flat in a block Self contained studio flat (private use of a bed or living area & kitchen & bathroom/toilet do not tick if you share any of this accommodation) Residential nursing home Other - give details Does your home have central heating? Does your home have a garage? How many floors are there? Does your home have cooking facilities? Do you and your household occupy only part of the building you have ticked? Where in the building do you live? At the front In the middle At the back Left Right How many floors are in your building Which floors do you live on? For example, ground floor, first floor. How many rooms are there in the building? Number of rooms in the whole building Number of rooms for you and your household only Number of rooms that you share with other people Living rooms Bedsitting rooms Bedrooms Bathrooms or shower rooms Toilets Kitchens Other rooms 10

Part 5 About where you live - continued Do you or your partner use your home for business? Do you or your partner have a main home somewhere else? If your main home is somewhere else in the UK or abroad, tick, even if you do not pay rent for it. What is the address? Please tell us about it below Do you or your partner pay rent on this home? Part 6 About income support, income-based Jobseekers Allowance, income-related Employment and Support Allowance and Pension Credit Guarantee Credit. You Your partner Are you or your partner actually getting Income Support, income-related Employment and Support Allowance, income-based Jobseekers Allowance or Pension Credit Guarantee Credit at the moment? When did you start getting it? When did you start getting it? Are you or your partner still waiting to hear about a claim for Income Support, income-related Employment and Support Allowance, income-based Jobseekers Allowance or Pension Credit Guarantee Credit? Go to Part 7 When did you claim? Go to Part 7 When did you claim? Part 7 About being self-employed You Your partner If you are self employed please contact your local office for the additional forms Are you or your partner self-employed? Go to Part 8 Answer the questions in this part Go to Part 8 Answer the questions in this part You must provide 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 evidence of your income. We will write to you about this. 11

Part 7 About being self-employed - continued You Your partner What kind of work do you do? When did the business start? What is the business address? Do you have any business partners? Tell us their names and addresses Tell us their names and addresses What % of the total profit / loss is yours? % % How many hours a week do you usually work? Do you get a Business Start-up Allowance? How much and how often? How much and how often? every every We need to see proof of this We need to see proof of this Do you pay into a private pension scheme? How much and how often? How much and how often? every every We need to see proof of this We need to see proof of this Is self-employment your only form of employment? If no, Part 8 about working for an employer must be completed If no, Part 8 about working for an employer must be completed What date did you start trading? How much did/do you earn each week? We must see evidence of your accounts before we decide how much benefit you can get. Read the checklist at Part 15 to see what you can use as proof. 12

Part 8 Do you or your partner work for an employer? About working for an employer What kind of work do you do? What is your employer s name and address? You Go to Part 9 Your partner Go to Part 9 Answer the questions in this part Answer the questions in this part We must see evidence of your earnings before we can decide how much benefit you can get. Read the checklist at Part 15 to see what you can use as evidence. If you work for more than one employer, tell us about all your employers on a separate sheet of paper and send it with this form. If you are sending a separate sheet of paper, tick this box. When did you start this job? What is your payroll, employee or staff number? Are you employed for a limited period? When will you finish When will you finish How often do you get paid? Every Every How much do you get paid before tax and National Insurance are taken off? Do you receive bonuses, tips or commission? If yes, is it included in the figure above? How are you paid, for example, in cash, by cheque or straight into a bank or building society account? When was your last pay rise? Please provide proof of the amount Please provide proof of the amount When will your next pay rise be? How many hours a week do you usually work? Are you getting Statutory Sick Pay (SSP), Statutory Paternity Pay (SPP), Adoption Pay, Statutory Maternity Pay (SMP) or any other sick pay or maternity pay from your employer at the moment? When did it start? State which type State which type Do you pay into a private or company pension scheme? How much and how often? How much and how often? Every Every 13

Part 9 About any other work Do you or your partner do any other work at all? This could be voluntary work or any other work, even if it is not paid work. What other work do you do? What is the name and address of the person you do this work for? You Go to Part 10 Tell us about it below Your partner Go to Part 10 Tell us about it below When did you start this work? How many hours a week do you usually work? Do you get paid? If you only get expenses or tips, still tick and give details. How much do you get before any deductions? Tell us about it below Tell us about it below every every How often are you paid? every every How is it paid? Part 10 About benefits and pensions You Your partner Are you or your partner getting any benefits or waiting to hear about benefits you have claimed? Go to Part 11 Tell us about the benefits below. Tell us the full rate of the benefits before any deductions. Go to Part 11 Read the list of benefits below and tell us about any you or your partner are getting now or have claimed. Tell us about the benefits below. Tell us the full rate of the benefits before any deductions. Type of Benefit You Your Partner How Often Tick if benefit claimed & awaiting decision Working Tax Credit Child Tax Credit Child Benefit Guardian s Allowance Fostering Payment Adoption Allowance Jobseekers Allowance (contribution based) Employment and Support Allowance (contributory) Incapacity Benefit - Short Term Low Rate 14

Part 10 About benefits and pensions - continued Type of Benefit You Your Partner How Often Tick if benefit claimed & awaiting decision Incapacity Benefit - Short Term High Rate Incapacity Benefit - Long Term Rate Severe Disablement Allowance Industrial Injuries Disablement Benefit Industrial Death Benefit Maternity Allowance Bereavement Allowance Widowed Parents Allowance Retirement Pension Pension Credit (Savings Credit) War Disablement Pension War Widow s/widower s Pension War Widow s/widower s Special Payment/Pre 1973 Please note that if you are getting your benefit or pension paid into a Bank or Building Society Account or a Post Office account you must also give details of this account in Part 12. Part 11 About other money coming in Have you or your partner or any children you are claiming for, have any money coming in (or expect to have some money coming in) that you have not already told us about on this form? Go to Part 12 Answer the questions on this page. You do not need to tell us about payments from the Independent Living Fund, the Eileen Trust or the MacFarlane Trust Student Loan Other Money You Your Partner How Often Tick if money claimed & awaiting decision Student Bursary Student Grant Maintenance Payments/Child Support Occupational/Works Pension Private Pension Income from Boarders Income from Sub-Tenants 15

Part 11 About other money coming in - continued Other Money You Your Partner How Often Tick if money claimed & awaiting decision Annuity Payments Charitable Payments Training Scheme Payments/Allowance Any Other Income/Payments We must see evidence of any income before we decide how much benefit you can get. Read the checklist at Part 15 to see what you can use as proof. Part 12 About savings, investments and property If you have any savings in more than one account or shares etc in more than one company, please give details in the space provided at Part 13. Do you or your partner have any savings, investments, money not invested, property or land in the UK or abroad? This includes cash, current accounts and savings accounts with a bank or building society, post office accounts, premium bonds, National Savings Certificates, and stocks and shares. Do you or your partner have any of the following? Money in bank accounts If you have more than one account, please give details in the space provided at Part 13 Money in Building Society accounts If you have more than one account, please give details in the space provided at Part 13 Money in Post Office accounts If you have more than one account, please give details in the space provided at Part 13 Cash Go to Part 13 Answer the questions in this part. Current balance Name of the bank Account number(s) Current balance Name of the building society Account number(s) Current balance Account number(s) Amount Number of Accounts Number of Accounts Number of Accounts Premium Bonds Amount Unit trusts, ISAs, PEPs, TESSAs or other investments Amount Name of the company the investments are held in 16

Part 12 Income bonds or capital bonds Money or property held in trust Shares approximate value About savings, investments and property - continued Amount Amount Amount Name of the company the bonds are held in Name of the company the shares are held in Number of shares held Stocks approximate value Amount Name of the company the stocks are held in Number of stocks held Any other savings or investments Do you or your partner have any National Savings Certificates? Do any of your savings or investments include: money from the sale of a house, or money from a charity? Apart from your home, do you or your partner own any other property or land in this country or abroad? Address Amount Type of other savings/investments We must see evidence of any savings, investments or property before we decide how much benefit you can get. Read the checklist at Part 15 to see what you can use as proof. Please list the date purchased and issue number in the space provided at Part 13. Please provide us with the original certificates as proof. We will write to you about it. We will write to you about it. If it is on a mortgage or a loan, still tick. Please confirm the outstanding amount : You Your partner Have you or your partner received a Far Eastern Prisoner of War Compensation We will write to you about it. We will write to you about it. Have you or your partner received a compensation payment made to victims of atrocities that happened during the Second World War? Have you or your partner received a payment from the vcjd (Creutzfeldt-Jacob Disease) Trust? We will write to you about it. We will write to you about it. We need to know this to make sure we do not count it as part of your savings. We will write to you about it. 17

Part 13 Anything else you need to tell us Please use the space below to tell us anything else you think we should know about. Use a separate sheet of paper and attach it to this form if you need to. If you are sending any separate sheets of paper with this form, tell us how many. 18

Part 14 Backdating We can usually award benefit from the Monday after the day we receive your claim. Sometimes we can pay benefit from an earlier date if you have a good reason for not claiming earlier. If you want us to consider paying your benefit from an earlier date, tell us when you want benefit from and why you did not claim earlier. Your benefit will not be backdated unless you are able to show good reason for not claiming earlier and that good reason exists for all of the period. Please note that benefit can only be backdated for a specific period depending on your circumstances. Date you want to claim benefit from For this earlier period, were you or your partners circumstances the same as on this form? Tell us on a separate sheet what you or your partners circumstances were Tell us why you have not claimed before. The reason you give must apply for the whole period you are claiming for. Use a separate sheet of paper and attach it to this form if you need to 19

Part 15 Checklist Please tick to say what evidence you are sending with this form. We must see original documents, not copies. Please do not send valuable items through the post. If you can, bring them into our office. We will take the details we need and give you the documents back straight away, and give you a receipt for those documents. If you cannot get into the office, phone us for more advice. If you do not provide all the evidence we need, we might not be able to pay you any benefit. We need the same evidence for your partner, if you have one. If you cannot send the evidence we need at the moment, send the form back to us now and send the evidence later. We can start to process your claim, but we will not be able to pay you any benefit until we have all the evidence. Evidence of identity Such as birth certificate, marriage certificate, passport, National Insurance number card, medical card, driving licence, UK residence permit, EEC identity card or recent gas or electricity bill etc. Evidence of National Insurance number Such as a National Insurance number card, payslips or letters from the Department for Work and Pensions or Her Majesty s Revenues and Customs. Evidence of your address Such as a recent gas or electricity bill, a TV licence, driving licence, UK residence permit or a letter from a solicitor, social worker, or probation officer addressed to you etc. Evidence of n-dependants Income In order to receive the lower non-dependant deduction (where applicable) proof of the non-dependant s income must be provided. Failure to provide proof shall result in the highest deduction being applied. Evidence of other People If you have answered yes to any questions in Part 3 of this application you must provide evidence. Please ask for advice at your local office if you are unsure of the evidence required. Evidence of other money paid out Such as letters about student grants, maintenance payments or receipts from your registered childminder. Evidence of private rent and tenancy Such as a rent book, rent receipts, a tenancy agreement or a letter from your landlord. The evidence must include the following and, therefore, more than one item from the above list may be required to obtain all of the necessary information required. the name and business address of the landlord, the name and business address of the agent (if there is one), the date the agreement started, the amount payable, rent frequency and what is included in the rent. Evidence of earnings We also need this for any other adults living in your home who are aged 18 or over. This means your last five payslips if you are paid every week, your last three payslips if you are paid every two weeks, or your last two payslips if you are paid every four weeks or every month. Alternatively you can ask your employer to complete the wage certificate attached to the back of the form. Evidence of self-employed earnings If you or your partner are self-employed, we need to see your accounts for the last financial year or, if you have been trading for less than six months, a summary of your trading records so far. If the business has started recently and you have received Business Start-Up Allowance you must provide proof. Evidence of benefits, allowances or pensions We also need this for any other adults living in your home. Such as current award notices or letters from the Department for Work and Pensions confirming how much you get. If you do not have evidence, let us know straight away. Please do not send order books through the post. Evidence of other income We also need this for any other adults living in your home. Such as pension slips from a former employer or a letter from the court showing how much maintenance you are getting. We need to see evidence of any money people pay you for board and lodgings. Evidence of capital, savings and investments Such as all your bank, building society or post office books, full bank statements, or certificates for premium bonds, National Savings Certificates, ISAs, stocks, shares and unit trusts. We need to see evidence of any interest or dividends you get on investments and savings. We need to see this evidence for children in your household as well. The evidence you send must show details for at least the last two months. 20

Part 16 How you want to be paid If you are awarded Council Tax Reduction, South Ayrshire Council will pay this into your Council Tax account. If you are a council tenant, South Ayrshire Council will pay any Housing Benefit you are awarded into your rent account. If you are a tenant of a Housing Association, South Ayrshire Council will normally pay your benefit direct to the Housing Association. If you are not a council or Housing Association tenant and are awarded Housing Benefit, or after April 2008 Local Housing Allowance, South Ayrshire Council will pay your money direct into your bank or building society account. Please note that we cannot make payments into Post Office card accounts. Name of bank or building society: Branch Address: Account Name(s): Bank/Building Society Sort Code: Bank/Building Society Account Number: Bank/Building Society Roll Number: Signature of Account Holder(s): Date: If you do not currently have a bank or building society account, please either contact your local benefits office for advice or one of the local banks or building societies. There are branches of all major banks and building societies throughout South Ayrshire. If you do experience difficulty in managing your rent payments the council may be able to consider an alternative payment method. Please contact your local benefits office for an application form for Direct Payment. Are you responsible for paying the Council Tax on this property? Would you like us to use the bank details that you have provided above to allow you to pay your Council Tax, Water and Sewerage charges by direct debit? If please make sure that you have written your daytime phone number on page 1 of this form so that we can phone you to set up the direct debit. Alternatively, we may send you a paper mandate. The Council Tax Section should be contacted direct if you have any questions about the payment of your Council Tax. Council Tax Telephone Number 0300 123 0900 21

Part 17 Declaration Even if someone else has filled in this form for you, you must sign this document if you can. If you have a partner, they must sign this form also. Please read this declaration carefully before you sign and date it. I/we declare that the information given on this form is correct and complete to the best of my/our knowledge. I/we understand that if information is incorrect or incomplete, I/we may be prosecuted. I/we agree that you will use the information provided to process my/our claim for Housing Benefit or Council Tax Reduction, or both. You may check some of the information with other sources as allowed by the law. I/we understand that you may use any information provided in connection with this and any other claim for social security benefits that I/we have made or may make. You may give some information to other organisations, such as government departments or local authorities, if the law allows this. I/we know that I/we must let you know in writing about any change in my/our circumstances which regulations under the Social Security Administration Act require me/us to notify in writing which occur after this claim. I am/we are legally required to report any changes and may be prosecuted for failure to do so. I/we know that the council must be notified within 1 month, in writing, of any changes in circumstances. I/we understand that this includes things like - If I/we change my/our address. - If my/my partner s/my/our dependants/other persons in the household income or benefit goes up or down. - If my/my partner s/my/our dependants/other persons in the household capital goes up or down. - If my/my partner s Income Support, income-related Employment and Support Allowance, income-based Jobseekers Allowance or Pension Credit Guarantee Credit stops. - If I/my partner start working or change jobs. - If I/my partner goes into hospital - If anyone joins or leaves my/our household. Signature Date: Partner s Signature Date: Forms filled in by someone other than the person claiming. Please tell us why you are filling in this form for someone else. Name of the person who filled in the form Signature of the person Relationship to the person claiming South Ayrshire Council is registered under the Data Protection Act 1998. The information collected, on this form and from supporting evidence, by South Ayrshire Council will be used to process your Housing Benefit and Council Tax Reduction claims. The information may be passed to the Department for Work and Pensions and Her Majesty s Revenues and Customs as permitted by law. We may check information provided by you, or information about you provided by a third party, with other information held by us. We may also get information from third parties, or give information to them to check the accuracy of information, to prevent or detect crime, or to protect public funds in other ways, as permitted by law. These third parties include Government Departments and local authorities and credit reference agencies which may include checks on undeclared cohabiters. We will not disclose information about you to anyone outside South Ayrshire Council nor use information about you for other purposes unless the law permits us to. 22

Part 18 Equalities Questionnaire A. Please indicate which background you feel you belong to: Asian Bangladeshi Indian Pakistani Kashmiri Other Asian background Please specify Mixed Ethnic Background Asian and White Black African and White Black Caribbean and White Other mixed ethnic background Please specify Black African Caribbean Other Black background Please specify White Any White background Chinese Any Chinese background Any Other Ethnic Background Any other background Please specify B. Please indicate your Nationality British or mixed British Scottish English Welsh Irish Any other nationality Please specify Completed questionnaire to be returned with the booklet. 23

Certificate of Earned Income You Certificate of Earned Income To be completed by the employee Name: Address: Employee/Works Number: Occupation: Signature: To be completed by the employer I would be grateful if you would assist your employee by confirming the details above. Please provide the information requested below and return it to South Ayrshire Council. Please indicate how often the employee is paid. If other applies please give the period: Pay period ending Weekly Fortnightly Calendar Monthly 4 Weekly Other (please specify) Please indicate the method of payment: Cash Cheque Direct to Bank Account Number of hours worked rmal Basic Wage: per week: Please complete the table underneath with the employee s gross pay for the last 5 weekly, 3 fortnightly or 2 monthly/4 weekly period (including overtime, bonus, SSP, SMP, etc). of hrs worked per week Gross pay Gross pay to date Tax paid by employee for this Pay Period Tax paid by employee YTD Occupational Pension Contributions National Insurance Contributions for this Pay Period National Insurance Cont -YTD If Statutory Sick Pay or Maternity Pay is included in the gross pay please state: which Name: Business Name: date started Business Address: Business Telephone Number: I confirm that the information I have given is true and complete Signature: Position in Firm: PLEASE ENDORSE WITH EMPLOYER S AUTHORISATION STAMP 24

Certificate of Earned Income Your Partner Certificate of Earned Income To be completed by the employee Name: Address: Employee/Works Number: Occupation: Signature: To be completed by the employer I would be grateful if you would assist your employee by confirming the details above. Please provide the information requested below and return it to South Ayrshire Council. Please indicate how often the employee is paid. If other applies please give the period: Pay period ending Weekly Fortnightly Calendar Monthly 4 Weekly Other (please specify) Please indicate the method of payment: Cash Cheque Direct to Bank Account Number of hours worked rmal Basic Wage: per week: Please complete the table underneath with the employee s gross pay for the last 5 weekly, 3 fortnightly or 2 monthly/4 weekly period (including overtime, bonus, SSP, SMP, etc). of hrs worked per week Gross pay Gross pay to date Tax paid by employee for this Pay Period Tax paid by employee YTD Occupational Pension Contributions National Insurance Contributions for this Pay Period National Insurance Cont -YTD If Statutory Sick Pay or Maternity Pay is included in the gross pay please state: which Name: Business Name: date started Business Address: Business Telephone Number: I confirm that the information I have given is true and complete Signature: Position in Firm: PLEASE ENDORSE WITH EMPLOYER S AUTHORISATION STAMP 25