Application For Housing Benefit, Local Housing Allowance And Council Tax Reduction - Carmarthenshire County Council Page 30
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32If you are completing this form you must ensure
that your full name and address is provided
HBB
along with your claim number (if known).
Housing Benefit/Council Tax Reduction
CERTIFICATE OF EARNINGS
CLAIM NO:
Note to Applicant: Please complete Section A and ask your employer to complete Section B or C and D.
The completed form should be returned to the Council.
A
Applicant’s Name: _______________________________________________________________________
Address: _______________________________________________________________________________
______________________________________________________________________________________
Post Code: ____________________________ Occupation: _____________________________________
Nat. Ins. Number: _______________________ Works/Payroll No: ________________________________
Note to Employer: Please assist the applicant by completing Section B or C below showing the latest 5 weeks or
2 months pay, and Section D.
B
WEEKLY PAID EMPLOYEES
Gross Pay
Income Tax
Employee’s
Employee’s
NETT
Nat. Ins.
Pension
Contr.
£
p
£
p
£
p
£
p
1. Week ending
/
/
2. Week ending
/
/
3. Week ending
/
/
4. Week ending
/
/
5. Week ending
/
/
Total
C
MONTHLY PAID EMPLOYEES
Gross Pay
Income Tax
Employee’s
Employee’s
NETT
Nat. Ins.
Pension
Contr.
£
p
£
p
£
p
£
p
1. Month ending
/
/
2. Month ending
/
/
Total
Does the information above represent the employee’s normal average income? Enter YES or NO
If not please enter details of
average
D
1. Date employment commenced ____________________________________________________________
2. Date of last pay increase _________________________________________________________________
3. Hours worked weekly ____________________________________________________________________
4. If figures given above include amounts for Statutory Sick Pay, please give dates involved:-
S.S.P Commenced ___________________
S.S.P still in payment/ended ___________________
The employer is requested to sign this form and authenticate it by the firms official stamp.
Signature of Employer ______________________________________________________________________
Business Address _________________________________________________________________________
________________________________________________________________________________________
Employer’s Tel. No.
Please complete and return to - Ty Elwyn, Llanelli, Carmarthenshire SA15 3AP
30
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