Housing Benefit And Council Tax Support Claim Form Page 2
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18Part A
About you and your partner
1.
What do you want to claim?
Housing Benefit
Council Tax Support
Both
2.
Do you have a partner?
Yes
No
If ‘Yes’, you must answer all questions about them. By partner we mean a person you are married to or a
person you live with as if you are married to them, or a civil partner or a person you live with as if you are
civil partners.
You
Your Partner
3.
Title (Mr, Mrs, Ms, other)
4.
Last name
5.
First name(s)
/
/
/
/
6.
Date of birth (dd/mm/yyyy)
!
7.
National Insurance Number
8.
Please tell us of any other
names you have used before
9.
The address you want to claim for
Postcode
10.
What date did you move
/
/
/
/
into the property?
11.
Are you the only person in the
If ‘Yes’, from
Yes
No
/
/
property over the age of 18?
what date?
12.
Are you temporarily absent
Yes
No
Yes
No
from the property?
If ‘Yes’, please tell us when this absence started, when you expect to return and the reason for absence.
/
/
/
/
Date absence started
Date you expect to return
/
/
/
/
Please tell us your reason for absence in Part K.
13.
Phone number(s)
14.
Email address
15.
We will send your benefit award letters and Council Tax bills (if you are the taxpayer) to you by email.
If you do not want us to do so, tick this box
Page 2
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