Housing Benefit & Council Tax Support claim form - Taunton Deane ...

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Part 6. Self-employment employer Are you or your partner self-employed? You No Go to Part 7 Yes Your partner When did you start this job? / / / / What kind of work do you do? What is the business name and address? How many hours a week do you work? If you have audited accounts, when will they be ready? Do you pay into a pension scheme? Postcode Postcode / / / / Yes No Yes No If Yes, how much do you pay? £ every £ every Do you get a Business Start-Up Allowance? Yes No Yes No If Yes, how much do you get? £ £ We must see proof of your self-employment income. See the checklist on page 21 Part 7. Any other work or income from a business Are you or your partner a director of any limited company or receiving an income or dividend from any business? This could be income you get from an investment or as a silent partner If Yes, how much do you or your partner get? £ How often do you receive it? every Yes No No Go to Part 8 Do you or your partner do any other work at all? Yes This could be voluntary work or any other work, even if it is not paid work You Your partner When did you start this job? / / / / What other work do you do? What is the name and address of the person you work for? How many hours a week do you work? Postcode Postcode Do you get paid? Yes No Yes No If you only get expenses or tips, still tick Yes and give details How much do you get before any deductions? £ £ How often do you get paid? every every page 10
Part 8. Benefits, pensions & allowances Are you or your partner getting any benefits, pensions or allowances or are you waiting to hear about a claim for any benefit, pension or Yes allowance? Read the lists below and tell us about any benefits, pensions or allowances you or your partner have claimed or get now. Tell us the full rate of benefits, pensions or allowances before deductions. Benefits for illness or disability Other Benefits Attendance Allowance Bereavement Allowance Carer’s Allowance Child Benefit Disability Living Allowance Child Tax Credit Employment and Support Allowance Fostering or adoption allowance Incapacity Benefit Government Training Allowance Industrial Death Benefit Guardian’s Allowance Industrial Injuries Disablement Benefit Jobseeker’s Allowance (contributions-based) Mobility Supplement Maternity Allowance Personal Independence Payment Statutory Adoption pay Severe Disablement Allowance Statutory Maternity or Paternity Pay Statutory Sick Pay Widow’s or Widower’s Benefit War Disablement Benefit Working Tax Credit Pensions Universal Credit Pension Credit State Retirement Pension War Pension or War Widow’s Pension No Go to Part 9 If you are getting or have claimed any benefit not listed, make sure you tell us about it You Your partner The name of the benefit, pension or allowance. Waiting to hear? Yes No Yes No Getting now? Yes No Yes No Amount received £ £ How often? every every The name of the benefit, pension or allowance. Waiting to hear? Yes No Yes No Getting now? Yes No Yes No Amount received £ £ How often? The name of the benefit, pension or allowance. every ery every Waiting to hear? Yes No Yes No Getting now? Yes No Yes No Amount received £ £ How often? every every We must see proof of your benefits, pensions or allowances. The checklist on page 22 tells you what we need. page 11
Page 1 and 2: Claim for Council Tax Support and H
Page 3 and 4: Housing Benefit and Council Tax Sup
Page 5 and 6: Part 1. You and your partner (conti
Page 7 and 8: Part 3. Other people living in your
Page 9: Part 5. Working for an employer Do
Page 13 and 14: Part 11. Bank accounts, savings and
Page 15 and 16: Part 13. Temporary absence Are you
Page 17 and 18: Part 14. Paying rent (continued) Wh
Page 19 and 20: Part 17. Any other information Is t
Page 21 and 22: Part 20. Checklist Please tick to
Page 23 and 24: Direct Payment Form - Landlord’s
Page 25 and 26: Name of person claiming benefit Pro
Page 27 and 28: page 27 Private and Confidential Em

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