A Claim Form For Housing Benefit And Council Tax Support Page 25

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Slough Borough Council, Benefit Service, P.O Box 1032, Slough, Berkshire SL1 3YT
Statement of Rent
This form is to be completed by the landlord/agent or property owner. All sections must be completed.
Mr
Mrs
Miss
Ms
Tenant’s full name:
First name:
Surname:
Address and postcode:
Address:
Please state room/flat number
Postcode:
where applicable
/
/
/
/
Tenancy Start Date:
Tenancy End Date:
First name:
Mr
Mrs
Miss
Ms
Landlord/Agent’name:
Surname/Agency:
Address and postcode and phone
Address:
number: Please state room/flat
Phone Number:
number where applicable
Are you the owner of the property let? If NO, please give details below.
Yes
No
Mr
Mrs
Miss
Ms
Owner’s Full Name:
Address:
Address and postcode and phone
number:
Postcode:
Phone Number:
Is the tenant or the tenant’s partner related to:
The Landlord?
Yes
No
The Agent?
Yes
No
The Owner?
Yes
No
If YES, please state what the relationship is:
Who is the relationship between?
Are any of the children living in the property related to:
The Landlord?
Yes
No
The Agent?
Yes
No
The Owner?
Yes
No
If YES, please state what the relationship is:
Who is the relationship between?
Yes
No
Is the property solely in the name of the above tenant?
If NO, please give the name(s) of the other joint tenant(s)
Please state the amount chargeable to each tenant
£
How much is the full rent for the property?
£
How often is this sum due?
Weekly
Monthly
Four Weekly
Fortnightly
Other
(give details)
Is the tenant more than 8 weeks in arrears with their rent?
Yes
No
If YES, by how much are they in arrears?
£
What type of tenancy does the tenant hold?
eg assured, shorthold etc.
How much notice is required should this tenant wish to leave?
Who is responsible for the internal decorating?
Landlord
Tenant
Fully Furnished?
Partly Furnished?
Unfurnished?
Is the accommodation:

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