A Claim Form For Housing Benefit And Council Tax Support Page 2

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Part 1
About you and your partner
page 2
continued
You
Your partner
Have you or your partner
No
No
claimed Housing Benefit or
Yes
Please tell us about it below.
Yes
Please tell us about it below.
Council Tax Support before?
When did you last claim?
/
/
/
/
Which council did you claim
from?
What name did you use for
the claim?
What address did you claim
for?
Postcode
Postcode
If you have moved from this
No
No
address, have you told the
Yes
Yes
council you claimed from?
If you or your partner have
moved home in the last
12 months, tell us your last
address if it is different from
above.
Postcode
Postcode
Tell us whether you were the
homeowner, a private tenant, a
council tenant or a lodger at this
address.
Have you or your partner come
to live in England, Northern
Ireland, Scotland, Wales, the
No
No
Republic of Ireland, the
Yes
We will write to you about this.
Yes
We will write to you about this.
Channel Islands or the Isle of
Man in the last two years?
What is your nationality?
If your nationality is not
/
/
/
/
British, on what date did you
last enter and apply to stay in
the UK?
The UK is England, Northern Ireland, Scotland and Wales.
Are you or anyone included in this application:-
• an asylum seeker
Yes
No
• subject to immigration rules
Yes
No
• granted exceptional, extended or indefinite leave to enter or remain in the United Kingdom
Yes
No
• Is this leave conditional or sponsored
Yes
No
Have you or anyone included in this application been given leave to
enter the United Kingdom for education or employment reasons?
Yes
No
If you answer Yes to any of the above, please provide proof of your status with travel documents, Home Office documents or passport
Are you or your partner in
No
No
hospital at the moment?
Yes
Please tell us about it below.
Yes
Please tell us about it below.
When did you go in?
/
/
/
/
When will you come out, if you
/
/
/
/
know this?
Are you or your partner in
No
No
receipt of any advice from a
Yes
We will write to you about this.
Yes
We will write to you about this.
care worker, social worker or
an appointee?

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