A Claim Form For Housing Benefit And Council Tax Support Page 6

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Part 3
About other people who live with you
page 6
continued
First person
Second person
Third person
Do they have any other
income at all?
No
No
No
Make sure you tell us about
Yes
Tell us about it below
Yes
Tell us about it below
Yes
Tell us about it below
all other income they have.
This includes any benefits or allowances you have not told us about on this form and interest from savings and investments.
1 Where does this income
come from?
How much is it before
£
£
£
deductions?
2 Where does this income
come from?
How much is it before
£
£
£
deductions?
3 Where does this income
come from?
How much is it before
£
£
£
deductions?
We need to see proof of their
We need to see proof of their
We need to see proof of their
income.
income.
income.
Are any of the people who
No
normally live with you
Yes
Tell us their names below.
married to each other or in a
civil partnership or living
is the partner of
together as if they were
married? We call these
is the partner of
people partners.
Part 4
About Income Support, income-based Jobseeker’s Allowance,
income-based Employment Support Allowance and Pension Credit
Are you or your partner getting or waiting to hear about
No
Go to Part 5.
a claim for Income Support, income-based Jobseeker’s
Allowance, income-based Employment Support
Yes
Answer both the questions in this part.
Allowance or Pension Credit?
You
Your partner
Are you or your partner
No
No
actually getting Income
Support, income-based
Yes
When did you start getting it?
Yes
When did they start getting it?
Jobseeker’s Allowance,
income-based Employment
/
/
/
/
Support Allowance or Pension
Credit at the moment?
Are you or your partner still
No
No
waiting to hear about a
Yes
When did you claim?
Yes
When did they claim?
claim for Income Support,
income-based Jobseeker’s
/
/
/
/
Allowance, income-based
Employment Support
Allowance or Pension Credit?
Which benefit are you getting
Which benefit are they getting
or waiting to hear about?
or waiting to hear about?
Income Support
Income Support
income-based Jobseeker’s Allowance
income-based Jobseeker’s Allowance
income-based Employment Support
income-based Employment Support
Allowance
Allowance
Pension Credit
Pension Credit
We must see evidence of your benefits, allowances or pension before we can decide how much benefit you can get. Read the
checklist at Part 15 to see what you can use as evidence.

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