Housing Benefit Appeal Form

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Housing Benefit appeal form
A
Revenues and Customer Support
York House
91 Granby Street
Leicester LE1 6FB
Full name and title
Your address
(and the address of
claim, if different)
Your phone n umber
Tick the relevant box
Are you:
The claim ant?
The l andlord?
Other?
If you are not the claimant, who is the claimant, and if you are not the landlord, what is your relationship to the claimant?
Part two: your representative’s details
(We advise you to get their help with completing part three of this form)
Name and address of
your representative
Their phone number
I give permission for you to disclose personal information relevant to my Housing Benefit
appeal to the representative above
(tick this box to indicate this)
Let us know if you want to change this arrangement
Part three: your appeal details
Date of our letter informing you of the
decision you are disputing

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