A Claim Form For Housing Benefit And Council Tax Support Page 9

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Part 7
About any other work
page 9
continued
You
Your partner
What is the name and
address of the person you
do this work for?
Postcode
Postcode
When did you start this
/
/
/
/
work?
How many hours a week do
you usually work?
Do you get paid?
No
No
If you only get expenses or
Yes
Tell us about it below.
Yes
Tell us about it below.
tips, still tick Yes and give
details.
How much do you get before
£
£
any deductions?
How often are you paid?
every
every
We must see evidence of any earnings before we can decide how much benefit you can get. Read
the checklist at Part 15 to see what you can use as evidence.
Remember to tell us about Working Tax Credit in Part 8.
Part 8
About benefits and pensions
Read the list of benefits below and tell us about any you or your partner are getting now or have claimed.
• Child Benefit
• Industrial Injuries Disablement Benefit
• Guardian’s Allowance
• Child Tax Credit
• Industrial Death Benefit
• Pension Credit (including Savings Credit)
• Working Tax Credit
• Carer’s Allowance
• Retirement Pension
• Fostering Allowance
• Severe Disablement Allowance
• War Disablement Benefit
• Contribution-based Jobseeker’s Allowance
• Statutory Sick Pay
• War Pension or
• Maternity Allowance
• Statutory Maternity Pay
War Widow’s Pension
• Employment Support Allowance
• Statutory Paternity Pay
• Widow’s or Widower’s Benefit
• Contribution-based Employment Support
• Adoption Pay
• Personal Independence Payment
Allowance
• Bereavement Allowance
• Armed Forces Independence Payment
Are you or your partner getting any benefits or
No
Go to Part 9.
waiting to hear about benefits you have claimed?
Tell us about these benefits in the section below. Tell us the full rate
Yes
of the benefits before any deductions.
If you are getting or have claimed any benefit that is not listed, tell us about it on a separate sheet of paper and send it with the form.
If you are sending a separate sheet of paper, tick this box.
You
Your partner
The name of the benefit or
pension
Waiting to hear
How much, how often and by what method?
How much, how often and by what method?
Getting now
£
every
£
every
The name of the benefit or
pension
Waiting to hear
How much and how often?
How much and how often?
Getting now
£
every
£
every
The name of the benefit or
pension
Waiting to hear
How much and how often?
How much and how often?
Getting now
£
every
£
every

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