Housing And Council Tax Benefit Application - South Norfolk Council Page 2

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Who
Children (please attach a
Is Child
Are they
Male or
Date Of
receives
separate sheet if you need to
Tax Credit
registered blind
Female
Birth
the Child
add more information)
Received?
or disabled?
Benefit
M / F
Y / N
Y / N
M / F
Y / N
Y / N
M / F
Y / N
Y / N
M / F
Y / N
Y / N
Does anyone get carer’s allowance for looking after you or your partner?
Y / N
Does anyone stay overnight to provide care for you or your partner?
Y / N
Are any of the other adults over 16 related to you, or each other?
Relationship
Is related to
Is related to
Please give full details of everyone else aged 16 or over in your home. We will need to see proof of
all income received by them. Please supply original documents only; photocopies are not accepted.
Relationship to
Full Name
Date of Birth
National Insurance Number
you
Income type / Employer name
Gross Income
Frequency
Hours worked
Relationship to
Full Name
Date of Birth
National Insurance Number
you
Income type / Employer name
Gross Income
Frequency
Hours worked
Relationship to
Full Name
Date of Birth
National Insurance Number
you
Income type / Employer name
Gross Income
Frequency
Hours worked
2

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