A Claim Form For Housing Benefit

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A claim form for Housing Benefit and
Council Tax Support
LIB HBCTS1 02/13
If you are just claiming Second
Are you (please tick one box):
For office use only
Adult Rebate, only fill in Parts 1,
a council tenant?
an owner-occupier?
3, 14, 15, 16 and 17 of this form
Date of initial contact
a housing association or
a private tenant?
and please tick this box
social landlord tenant?
Local authority office
Part 1 About you and your partner
date stamp
Do you have a partner who normally lives with you?
No
We use partner to mean
Yes
If you have a partner, you must answer all the
• a person you are married to or a person you live with as if you
questions about them, as well as yourself.
are married to them, or
• a civil partner or a person you live with as if you are civil partners
Initials
You
Your partner
Surname or family name
Date of issue
Other names
Local authority office
date stamp
Any other names you
have used
Title (Mr, Mrs, Ms, other)
Address, including room
Initials
number if you have one
Do not tell us your
partner’s address if it is
the same as yours.
Date received
Postcode
Postcode
Local authority office
What date did you start
/
/
/
/
date stamp
living at this address?
National Insurance (NI)
number
If you do not have
You can find this on payslips or letters from the DWP
If your partner does
an NI number, or
not have an NI
or the tax office. We cannot normally decide your
claim if we do not have your NI number.
cannot find it,
number, or cannot
Initials
tick this box.
We need to see proof of this.
find it, tick this box.
We need to see proof of your and your partner’s identity and NI number. See the checklist at Part 15.

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