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

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Part 3. Other people living in your home (continued) First person Second person Do they have any other income? Make sure you tell us about any other income they have. This includes 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? Yes No Yes No £ £ £ £ Are any of the people who normally live with you married to each other or living together as partners (see page 3 for what we mean by partner) If Yes, tell us their names Yes No is the partner of (name) The checklist on page 22 tells you what we need for the people who live in your home. Part 4. Income based Jobseeker’s Allowance, Pensioner Guarantee Credit, income related Employment Support Allowance and Income Support Are you or your partner getting or waiting to hear about a claim for: income based Jobseeker’s Allowance, income related Employment Support Allowance, Pensioner Guarantee Credit or Income Support? No Go to Part 5 Yes Are you or your partner actually getting: income based Jobseeker’s Allowance, income related Employment Support Allowance, Pensioner Guarantee Credit or Income Support at the moment? Yes No If Yes, which benefit are you getting? When did you start getting it? / / Go to Part 13 If No, are you or your partner waiting to hear about a claim for income based Jobseeker’s Allowance, income related Employment Support Allowance, Pensioner Guarantee Credit or Income Support? Yes No If Yes, which benefit are you waiting for? When did you claim? / / page 8 We must see proof of your benefits or pensions before we can work out your claim. The checklist on page 22 tells you what we need.
Part 5. Working for an employer Do you or your partner work for an employer? No Go to Part 6 Yes If you work for more than one employer, use a separate sheet of paper to tell us all the information we ask for on this page and send it with the form. If you are sending a separate sheet of paper, tick this box. You Your partner When did you start this job? / / / / What kind of work do you do? What is the name and address of your employer? How many hours a week do you work? Postcode Postcode How often do you get paid? every every How much do you normally earn every week, or month? £ every £ every When was your last pay rise? / / / / When will your next pay rise be? / / / / How are you paid? For example, by cash, cheque or straight into a bank account? Do you pay into a pension scheme? Yes No Yes No If Yes, how much do you pay? £ every £ every Are you employed for a limited time? If Yes, when will you finish work? Do you receive a bonus, tips or profit sharing? Yes No Yes No / / / / Yes No Yes No If Yes, how much do you get? £ £ How often do you receive it? every every Are you currently getting Statutory Sick Pay, Statutory Paternity Pay, Statutory Adoption Pay or Statutory Maternity Pay? Yes No Yes No Are you currently getting any Yes No Yes No other sick pay or maternity pay from your employer? We must see proof of your earnings. The checklist on page 21 tells you what we need. page 9
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: Part 3. Other people living in your
Page 11 and 12: Part 8. Benefits, pensions & allowa
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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