A Claim Form For Housing Benefit And Council Tax Support (Page 18 of 28) in pdf

Part 16 Backdating

page 18

We can usually award benefit from the Monday after the day we receive your claim. Sometimes we can pay benefit from an

earlier date if you have a good reason for not claiming earlier. If you want us to consider paying your benefit from an earlier

date, tell us when you want benefit from and why you did not claim earlier.

Date you want to claim benefit from

For this earlier period, were your circumstances the

Yes

same as on this form?

Tell us why you have not claimed before. Please use this space to give your reasons.

If you need more space, please continue on a separate sheet of paper and send it with the form.

If you are sending a separate sheet of paper, tick this box.

Part 17a

Declaration

YOU MUST READ THIS PART. After you have read the declaration, you and your partner should sign and date it.

• I/We declare that the information I/we have given on this form is true and complete.

• I/We understand that if I/we give information that is not true or incomplete, you may take action against me/us. This may include

court action.

• I/We agree that you will use the information I/we have provided to process my/our claim for Housing Benefit or Council Tax Support,

or both. You may check some of the information with other sources as allowed by the law.

• I/We understand that you may use any information I/we have provided in connection with this and any other claim for social security

benefits that I/we have made or may make. You may give some information to other organisations, such as government departments,

local authorities and private-sector companies such as banks and organisations that may lend me/us money, if the law allows this.

• I/We know that I/we must let you know in writing about any change in my/our circumstances which might affect my/our claim.

• I/We understand that if I/we do not let you know about any change in my/our circumstances which might affect my/our claim you

may take action against me/us. This may include court action.

WARNING: It is a criminal offence to knowingly provide false information and/or to withold any information, in

order to fraudulently increase or obtain entitlement to Housing Benefit. You have a legal obligation to notify

Slough Borough Council of any changes in circumstance. Failure to do so may lead to prosecution. If anything to

do with your household, job, income or savings changes - please tell us. If you know of anyone committing fraud

please contact our fraud hotline on 01753 787876.

Who completed this form?

You

Your partner

Someone else

If this form was not completed by you, the person completing the form must complete Part 17b.

Signature of person claiming

Partner’s signature

Date

A Claim Form For Housing Benefit And Council Tax Support Page 18