Appeal Form - Calderdale Council Page 3
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4APPEAL FORM - YOU MUST COMPLETE ALL BOXES
About you
Full name
Date of birth
National insurance no.
Claim ref. no.
Address
Contact number
Have you arranged for someone to help you with your appeal? YES
NO
If YES, what is their full
name, address and
contact number?
About the decision
Which benefit are you appealing against? Housing Benefit
Council Tax Reduction
What is the date on the decision letter that you want to appeal against?
About your appeal
• Use the space on the other side of this form to say why you do not agree with the decision.
• You must say why you think the decision is wrong. It is not enough to say ‘I do not agree
with the decision’ or ‘the money I receive is not enough’.
• If you are appealing against more than one decision you must say why you do not agree
with each one.
• If you are appealing more than one month after the decision was made, you must say why
your appeal has been delayed.
Your signature
Signature
Date
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