A Claim Form For Housing Benefit And Council Tax Support Page 14
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28Part 12 About rent
page 14
continued
What is the property let as?
Furnished
Tick the box that applies.
Partly furnished
Hardly any furniture
Unfurnished
How much rent do you pay and how often?
£
every
For example, every week, every fortnight, every four
weeks, monthly.
Does anyone else share the rent with you and your
No
partner?
Yes
Tell us the details below.
Tell us their names and their relationship to you and
your partner.
How much of the rent do they pay and how often?
£
every
For example, every week, every fortnight, every four weeks,
monthly.
Has your rent changed in the last 12 months?
No
Yes
Send us proof of the date it changed and how much it changed.
When is the next rent increase due?
/
/
We must see evidence of your rent and tenancy before we can decide how much benefit you can
get. Read the checklist at Part 15 to see what you can use as proof.
Has your rent been registered as a fair rent by a rent
No
officer?
Yes
Please send us the notice of registration form RO5.
Do you have any weeks when you do not have to
No
pay rent?
Yes
How many in a year and when?
Are you behind with your rent?
No
Yes
By how many weeks?
Who has to pay the Council Tax bill for your home?
You or your partner
Tick the box that applies.
Your landlord
Someone else
Tell us who it is.
Please read the list below and tell us about anything which is included in your rent.
Meals
Water authority charges
Heating
Fuel for cooking
Hot water
Cleaning rooms or windows
Lighting
Laundry
Garage or parking space
Gardening
Personal care and support
Does your rent include money for any of the above?
No
Yes
Tell us what your rent includes in the section below.
What your rent includes?
How much you pay for this
£
every
What your rent includes?
How much you pay for this
£
every
If more than two items from the list are included in your rent, please tell us about any other items on a separate sheet of paper and send
it with the form.
If your rent includes meals, please tell us which meals it includes.
If your rent includes a garage, please tell us of you have to rent the garage as part of your tenancy agreement.
If you are sending a separate sheet of paper, tick this box.
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