NFDC HOUSING/COUNCIL TAX Claim form CL1

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8 About other State Benefits & Tax Credits Do you or your partner get any of these benefits? Yes If 'Yes', please give the details below and say when your benefit started, how much you or your partner are entitled to (which may be different from what you actually get) and how often. No Send us original evidence if you are getting any of these benefits Child Benefit Child Tax Credit Working Tax Credit Guardian's Allowance Maternity Allowance Widowed Parent’s Allowance Bereavement Allowance Any other benefit (Please say which) Date started You Your partner / / £ every £ every / / £ every £ every / / £ every £ every / / £ every £ every / / £ every £ every / / £ every £ every / / £ every £ every / / £ every £ every If you are getting any of these benefits you do not have to send us evidence Employment and Support Allowance Income Support Jobseeker’s Allowance (Income Based) Jobseeker’s Allowance (Contributions Based) / / £ every £ every / / £ every £ every / / £ every £ every / / £ every £ every 9 State Benefits & Tax Credits claimed (waiting to hear about) Have you or your partner claimed any State Benefits or Tax Credits that you are waiting to hear about? Yes No If ‘Yes’, please say what you have claimed and when you made your claim. Don’t forget to tell us when you hear about your claim – if you do not do this you may lose benefit or have to pay back benefit you are not entitled to. Date claim made: / / Office use: Ret’d to Clmnt ……………………. by ……………………….. on ….……………… reason ………………………………………… Page 6 of 8 CL1_2/14
10 About income Do you or your partner have any of the income shown below? Yes No If 'Yes', please give details below, saying how much you or your partner get and how often. If ‘No’, please go through the checklist below. Are you or your partner in employment? If “Yes”, you must fill in form CL4 giving details and also provide evidence of earnings. You must send us original evidence of any of this income You Your partner Yes No Yes No Maintenance you receive (other than for a child) £ every £ every Maintenance for a child £ every £ every Money from renting out property Please write down the address. (We may write to you for more information.) £ every £ every Money you get from boarders or lodgers £ every £ every Charitable or voluntary payments you get £ every £ every Any other money you get that you have not put down already (please say what it is) £ every £ every Before you go any further go through this checklist: Have you fully answered all the sections of the form(s), including if you have a partner and all the boxes on page 4? Yes (if not, please do so, or we will not be able to deal with your claim). Have you enclosed evidence of your (and your partners): • ID and National Insurance Number Yes No • Statements of all money, savings and investments Yes No N/A • All State and Occupational/Private Pensions Yes No N/A • All State Benefits Yes No N/A • Any other income Yes No N/A If you (or your partner) are working: • Have you filled in form CL4? Yes No • Have you enclosed recent payslips? Yes No (If the employment has only recently started a letter from the employer will do) • Have you enclosed evidence of Tax Credits? Yes No N/A If you are a tenant of a private landlord or of a housing association: • Have you filled in form CL2? Yes No • Have you supplied evidence of your rent, e.g. a tenancy agreement? Yes No Benefit is normally awarded from the Monday after we receive your claim. Do not delay sending back this form, even if you cannot provide all of the evidence we need. Make sure you tell us why you cannot, and when you expect to be able to provide it. Without all the information we cannot pay benefit! CL1_2/14 Office use: Ret’d to Clmnt ……………………. by ……………………….. on ….……………… reason ………………………………………… Page 7 of 8
Page 1 and 2: Form CL1 - Claim for Housing Benefi
Page 3 and 4: 3 About dependent children We need
Page 5: 6 About Pensions Do you get any pen

NFDC HOUSING/COUNCIL TAX Claim form CL1

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