A Claim Form For Housing Benefit And Council Tax Support (Page 23 of 28) in pdf

A Claim Form For Housing Benefit And Council Tax Support Page 23

Paying benefit to your landlord

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Please return to:

Slough Borough Council, Benefit Service,

P.O Box 1032, Slough, Berkshire SL1 3YT

If you want us to pay your benefit straight to your landlord, you must complete this section and sign this declaration.

Your

Your declaration

Landlords

Please pay my Housing Benefit straight to my landlord.

or agents

• I understand that I must always tell you about any change in my

address

circumstances.

• I understand that if I do not tell you about any change of

circumstances and you pay me too much benefit because of this, I

may have to pay back the extra benefit.

• I understand that I may be prosecuted if I do not tell you about any

change of circumstances.

• I confirm that the information provided is true and complete and I

understand that I may be prosecuted if I state something which

I know to be false or do not believe to be true.

Address

Signature

Full name

(in CAPITAL

Postcode

LETTERS)

Date

Your landlord’s declaration

I agree to accept Housing Benefit payments for the tenant named in this form and I am the owner of the property.

I agree to accept Housing Benefit payments for the tenant named in this form and I am authorised by the owner of the property

to act on his behalf and can produce evidence of this if required.

I understand that by law:

• I must tell you straight away if I find out about any change in the tenant’s circumstances

• you can stop paying benefit to me if I do not tell you about any change of circumstances

• I can be prosecuted if I accept Housing Benefit which I know I am not entitled to, and

• if you pay me too much Housing Benefit for any tenant, I may have to repay it. You can take the amount of overpaid benefit from the

benefit I get for any other tenants. This will not affect their rent.

I confirm that the information provided is true and complete and I understand that I may be prosecuted if I state something

which I know to be false or do not believe to be true.

Signature

Date

If Housing Benefit is paid directly to you, it will be paid by BACS. Please complete the details below.

Name of bank or building society

Address of the branch where your account is held

Postcode

The name in which the account is held

Account number

Sort code

Roll number (Building society accounts only)

A Claim Form For Housing Benefit And Council Tax Support Page 23

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