Housing Benefit And Council Tax Support Claim Form Page 3

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Claim_rev 39
17/9/09
22:22
Page 3
Part 2 About you and your partner
We must see proof of your and your partner’s identity and National Insurance numbers. You will find your National Insurance
Proof
number on your National Insurance card, ES40, P60, P45 or wage slips. We need to see your most recent entitlement letters
needed
from Jobcentre Plus, HM Revenue & Customs, The Pension, DIsability and Carers Service or The Department for Work and
Pensions. We also need to see proof of your immigration status if you are from abroad. See the help notes on pages 30 to
31 for details of the type of proof we need to see. We must see original documents, not photocopies.
Do you have a partner who normally
If Yes, you must answer all the questions
lives with you?
Answer Yes or No
below for you and for them.
About you
About your partner
Title
Mr
Mrs
Ms
Miss
Other
Mr
Mrs
Ms
Miss
Other
Your last name
Your first names
Any other names you
have been known by
/
/
/
/
Your date of birth
National Insurance number
2 letters
6 numbers
1 letter
2 letters
6 numbers
1 letter
Have you ever claimed Housing Benefit
or Council Tax Benefit or Council Tax
Answer Yes or No
Answer Yes or No
Support before?
If Yes, tell us the date you last
/
/
/
/
claimed.
Which council did you claim from?
What name did you claim in?
Please give the address you claimed
for, if it was different from your current
address.
/
/
Date you moved to
/
/
your current address.
Answer Yes or No
Answer Yes or No
Is this an exact date?
If you have moved in the last 12
months, give your previous address.
At this previous address were you the
owner-occupier or did you rent or live
with friends?
Have you come to live in the United
Kingdom, the Republic of Ireland, the
Channel Islands or the Isle of Man in
Answer Yes or No
Answer Yes or No
the last five years? (We may write to
you to ask you for more information
about your circumstances.)
If Yes, what is your nationality?
Lambeth Revenues and Benefits, Olive Morris House, 18 Brixton Hill, London, SW2 1RD
Page 3 of 32
Phone: 0845 300 0328
Website:

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