Housing Benefit And Council Tax Support Claim Form Page 19

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Claim_rev 39
17/9/09
22:24
Page 19
Part 17 About the charges you pay (continued)
Does your landlord live at the same
Answer Yes or No
address as you?
Answer Yes or No
Is the landlord your previous partner?
Have you ever owned or part-owned
Answer Yes or No
your current home?
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.)
If your landlord has an agent, tell us
their full name and address.
(By ‘agent’, we mean the person or
organisation you pay your rent to if it is
not the landlord.)
Are you or any member of your
household related to your landlord,
Answer Yes or No
your landlord’s agent or the trustee
who you pay rent to?
If Yes, what is the relationship?
(‘Related’ includes related through
marriage, even if the marriage has
ended.)
Part 18 Where you live
What sort of building do you live in? Please tick the box that best applies to your accommodation.
If you have ticked ‘Other
accommodation’, please give details
Bedsit
Detached house
Hostel with board and lodgings
below.
Studio flat
Semi-detached house
Residential care home
Double bedsit
Terraced house
Room or rooms
F
t a l
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If your accommodation is a room or rooms, bedsit,
double bedsit or studio flat, please give the room number.
Where is it in the building?
Please tick one box here. Front
Middle
Back
Please tick one box here.
Left
Middle
Right
Loft
How many floors are there in the building,
Fourth Floor
including the ground floor?
Third Floor
Second Floor
Which floor or floors do you live on?
First Floor
(Please tick the box or boxes next to the diagram that apply to you.)
Ground Floor
Basement
If the diagram does not show where you live,
please say which floor or floors you live on.
Lambeth Revenues and Benefits, Olive Morris House, 18 Brixton Hill, London, SW2 1RD
Page 19 of 32
Phone: 0845 300 0328
Website:

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