Housing Benefit And Council Tax Support Claim Form
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32Claim_rev 39
17/9/09
22:22
Page 1
Housing Benefit and Council Tax Support
Claim form
Do not write in this box. It is for office use only.
Office receipt date stamp
Date of issue:
Please read all of the notes shown on this page and on pages 2 and 29 to 31 of this form before you answer the questions.
You can use this form to claim Housing Benefit, Council Tax Support or Second Adult Rebate.
Proof
Proof
• Use black ink.
• Do not use pencil.
We need to see proof of some things
needed
• If you make a mistake, just cross it out and put the right answer next to it.
you tell us about.
• Do not use correction fluid.
We have put this sign where you
• Do not put a cross in any of the boxes.
need to send us proof. If you cannot
• If you answer a question with a cross, we may have to send the form back to
send in the proof we need with your
you and this will delay your claim.
claim form, send in your claim form
• If the part of the form applies to you, please answer with the correct details
anyway and send the proof to us
(write Yes, No or tick the box that applies).
within one calendar month.
Part 1 Your address and contact details
The address (including postcode) you
want to claim benefit for, including
your room number if you have one
Are you responsible for paying council
tax for this address?
Answer Yes or No
If Yes,
please give your council tax number.
If No, please give the full name of the
person who is responsible for paying
the council tax.
Your daytime phone number
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Your email address
If you have claimed benefits in
8
Lambeth before, please give your
benefit claim number.
If you live in a type of accommodation we have not
Are you:
a private tenant?
living in temporary accommodation?
mentioned, give details below.
(please tick
n a
o
w
n
r e
o -
c c
p u
e i
? r
i v i l
g n
n i
a
h
s o
e t
? l
one box)
a boarder?
living in a type of accommodation
we have not mentioned?
a housing-association tenant?
claiming Second Adult Rebate only?
a council tenant?
If you are only claiming Second Adult Rebate, only fill in parts 2, 4 and 24.
Lambeth Revenues and Benefits, Olive Morris House, 18 Brixton Hill, London, SW2 1RD
Page 1 of 32
Phone: 0845 300 0328
Website:
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