Housing Benefit Clam Form And Council Tax Reduction Page 10

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Page 10
Part 3
About other people who live with you
Do any adults usually
Go to Part 4 on page 13
No
live with you and your
How many other people are there?
Yes
partner?
If there are more than 3, use a separate sheet of paper to tell
By adults we mean
us all the information we need about them
people over 16 who
If you are sending a separate sheet of paper, tick this box
nobody gets Child
Benefit for.
First person
Second person
Third person
Last name
Other names
/
/
/
/
/
/
Date of birth
Their relationship to
you or your partner
Some examples of the relationship are aunt, brother, daughter, father, grandson, grandmother,
stepdaughter, joint tenant, joint owner, subtenant, lodger or friend
Do they get Income
Support, Income-
No
No
No
Based Jobseeker’s
Yes
Allowance or
Yes
Yes
Universal Credit?
Do they get Income-
related Employment
No
No
No
and Support
Yes
How much?
How much?
Allowance?
Yes
Yes
£
a week
£
£
a week
a week
Does it include either
No
No
No
a support or work-
related component?
Yes
Yes
Yes
When did they start
/
/
/
/
/
/
getting it?
Do they get Pension
No
No
No
Credit?
Yes
Yes
Yes
Do they get Disability
Living Allowance,
No
No
No
Personal Independence
Payment or Attendance
Yes
How much?
Yes
Yes
How much?
How much?
Allowance?
£
a week
£
£
a week
a week
Are they registered
No
No
No
blind?
Yes
Yes
Yes
Important! We need to see evidence that they are a student, for
example a student certificate.

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