Housing Benefit And Council Tax Support Claim Form Page 28

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Claim_rev 39
17/9/09
22:25
Page 28
Certificate of earnings or estimated earnings for the person claiming (continued)
Your employer should fill in this part.
Please give details of the employee’s pay, including any overtime, bonus and other payments.
• If they are paid every week, we need details of the last five weeks’ pay.
• If they are paid every two weeks, we need details of the last three payslips which cover six weeks’ pay.
• If they are paid every four weeks or every month, we need details of the last eight weeks’ or last two months’ pay.
• If you need to, please give an estimate of their earnings.
Payroll number
You must stamp the form with your official stamp here.
If you do not have an official stamp, send us a signed
National
sheet of your company’s headed paper.
Insurance
number
2 letters
6 numbers
1 letter
Amount of any
£
redundancy payment
If they no longer work for
/
/
you, what date did their
employment end?
How often are they paid?
(Please tick.)
Every week
Every two weeks
Every four weeks
Every month
How are they paid?
By cash
By cheque
By transfer
Other
(Please tick.)
Period covered
Date
Gross pay
Tax
Pension
National
Statutory
Hours
of pay
(before tax and National
contribution
Insurance
Sick Pay
worked
I
s n
r u
n a
e c
e d
u d
i t c
n o
) s
o c
t n
b i r
i t u
n o
Month 1, fortnight 1
/
/
£
£
£
£
£
or week 1
Month 2, fortnight 2
/
/
£
£
£
£
£
or week 2
Fortnight 3
/
/
£
£
£
£
£
or week 3
/
/
£
£
£
£
£
Week 4
/
/
£
£
£
£
£
Week 5
Gross pay to date
£
/
/
Date of next pay rise
Is this a rough date
Answer Yes or No
of the next pay rise?
Declaration
I declare that the information I have given is true and complete, and know that I may be prosecuted if I give false information.
E
m
p
o l
e y
s ’ r
s
g i
a n
u t
e r
P
s o
i t i
n o
/
/
r P
t n i
a n
m
e
D
a
e t
Lambeth Revenues and Benefits, Olive Morris House, 18 Brixton Hill, London, SW2 1RD
Page 28 of 32
Phone: 0845 300 0328
Website:

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