Housing Benefit And Council Tax Support Claim Form Page 16

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Part M
Equality Statement (Optional)
The Race Relations Amendment Act (2000) says that we need to make sure that we deal with everyone
equally and fairly. It would help us to know your ethnic background, so that we can make sure our services
meet your needs. We will only use this information as the law allows.
Please choose one section from 1 to 5, then tick the box that best describes your cultural background.
1.
White
4.
Black or Black British
British
Caribbean
Irish
African
Any other white background
Any other black background
(please tell us below)
(please tell us below)
5.
Other ethnic backgrounds
2.
Mixed
Chinese
White and Black Caribbean
Afghan
White and Black African
Kurdish
Any other mixed background
Roma
(please tell us below)
Any other background
(please tell us below)
3.
Asian or Asian British
Indian
Pakistani
Bangladeshi
Any other Asian background
(please tell us below)
Page 16

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