May 2015
Housing Benefit and Council Tax Support
Self-Employed Income and Expenses Form
Claim number:
Name :
Address:
Section 1 - About your business
Name of business:
Business address:
Do you have a website?
If so please give details:
What kind of work do
you do?
Date business started trading:
/
/
Date your current financial year started:
/
/
Average number of hours you work each week?
Is your business a partnership?
Yes
No
(Please tick one box)
If yes, what percentage of the business belongs to you?
%
Please provide your partnership agreement.
Do you use part of your own home for business purposes?
Yes
No
(Please tick one box)
If yes, please give details