Housing Benefit And Council Tax Support Claim Form (Page 26 of 32) in pdf

Housing Benefit And Council Tax Support Claim Form Page 26

Claim_rev 39

17/9/09

22:25

Page 26

Part 26 Payments direct to your landlord

If you want us to pay your Housing Benefit direct to your landlord or agent, please fill in part A below.

Then tear this page out and ask your landlord to fill in part B, sign it and send it back to us.

Part A You must fill this in

Your name

Your address

Your phone number

Housing Benefit reference number

(if you know it)

Part B Your landlord or agent (if there is one) must fill this in

Landlord’s name

Address

Phone number

Agent’s name (if there is one)

Address

Phone number

I am the landlord or agent named above or I have permission to sign on their behalf.

I would like the Housing Benefit for the tenant to be paid direct to our bank account. The details are as follows.

Name of bank or building society

Bank or building society’s address

Name of account holder

Account number

Sort code

Building society roll number

Landlord’s declaration

Please read the declaration before you sign this form.

I am the owner or the agent of the property the tenant is living in.

I agree to accept Housing Benefit payments for the tenant named above.

I understand that I must tell Lambeth Revenues & Benefits if I know about any change in circumstances that may affect this tenant’s benefit.

I understand that if I am overpaid benefit for this tenant, it can be recovered from me as allowed by the Social Security Administration Act 1992

and the Housing Benefit (General) Regulations 2006.

I have read and understood this declaration.

Landlord’s or

Date

agent’s signature

Please return this form to: Lambeth Revenues and Benefits, Olive Morris House, 18 Brixton Hill, London, SW2 1RD. Phone: 0845 300

0328

Lambeth Revenues and Benefits, Olive Morris House, 18 Brixton Hill, London, SW2 1RD

Page 26 of 32

Phone: 0845 300 0328

Website:

Housing Benefit And Council Tax Support Claim Form Page 26

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