Housing Benefit And Council Tax Support Claim Form
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18Housing Benefit and
Council Tax Support
claim form
If you are receiving Universal
Credit you cannot claim Housing
Benefit. If you need help with
your Council Tax please visit our
website to download a Council
Tax Support only form.
Reference number
About this form
Please fill in as much of this form as you can. You must fill in any part that is relevant to you and
all the questions in that part. Please use black ink to fill in this form and write your answers clearly.
When you have filled in the form, please return it without delay otherwise you may lose out.
If you cannot provide the proof we need, you can send it later.
If you need help completing this form or need other forms, please phone us or come into one of our
offices for advice. You can also find advice on our website. Our contact details are given at the back
of this form.
Where you see the sign
you must provide proof.
!
If you would like to apply for Second Adult Rebate only please fill in our Second Adult Rebate
form (you can download this form from our website). Please note that Second Adult Rebate is only
available for people of qualifying age for Pension Credit.
Please note: For Council Tax Support, where the word ‘claim’ is used this means ‘application’, and
where the word ‘claimant’ is used this means ‘applicant’.
For office use only
Date received
Date requested
Date issued
Page 1
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