Result

STATUS - INCOMPLETE
Date: 03/03/2021 23:25:52
Housing Benefit and / or Council Tax Support
Your unique reference code DCC71461
Eligibility
Who is applying?
Eligibility
About you
Your circumstances
About your partner
Your partner's circumstances
Capital and savings
About your children
Any other information
Summary
Declaration
Before we get into the full details of your household, income and expenditure,
please read the following statements and answer any questions. These questions
are mainly to check whether you would be eligible for help with your Council Tax
and/or rent and may save you from making an application where you may not
be entitled to receive any assistance.
Are you Working Age or Pension Age?
Working Age
Pension Age
Do you have a partner that lives with you?
Yes
No
Is your partner Working Age or Pension Age?
Working Age
Pension Age
What do you wish to apply for?
A reduction in your Council Tax
Help with paying your rent
Both of the above
Are you a British citizen?
If you are not sure you can check on gov.uk
Yes
No

Who is applying?
Before we start, we need to know if you are completing this claim for yourself or
on behalf of another person.
Please note that if you are completing this form as an appointee or power of
attorney, we will need to see evidence of your authority to act on the applicant's
behalf.
The 'Save' button at the top and bottom of each section can be used at any
time throughout this form to save the information you have provided.
Are you making a claim on behalf of another person?
Yes
No
To help us make a decision on this application, we will need to know about any
previous applications for Housing Benefit and/or Council Tax Reduction that you
have made.
Have you claimed Housing Benefit and/or Council Tax Reduction with this Local
Authority before?
Yes
No
Have you claimed Housing Benefit and / or Council Tax Reduction at any other
Local Authority before?
Yes
No

About you
Title
Mr
Forename(s)
Shevan
Surname/family name
Salim
Date of birth
Day Month Year
25 May 1977
Do you have a National Insurance Number?
Yes
No
What is your National Insurance Number?
SC602671D
What is your gender?
Male
Female
Your postcode:
De22 3re
Search
Search
Select your address:
DE22 3RE,35 RAMSHAW WAY,DERBY,,,072140350
DE22 3RE,5 RAMSHAW WAY,DERBY,,,072140050
DE22 3RE,7 RAMSHAW WAY,DERBY,,,072140070
DE22 3RE,9 RAMSHAW WAY,DERBY,,,072140090
Please confirm your address
9 RAMSHAW WAY
DERBY
Enter address line 3 here..
Enter address line 4 here..
Postcode *
DE22 3RE
Have you been placed in this property following an application for
Homelessness?
Yes
No
What date did/will you move into the property?
12/12/2013
From which date do you want your claim to start?
18/12/2020
Please provide the reason that you wish your claim to be backdated
Because from 18/12/2020 My work is finished and I become unemployed. I
am now entitled to universal credit.
Please provide your Council Tax account reference

What is your home phone number?
What is your mobile number?
07513038344
What is your email address?
Providing your email address will enable us to contact you more
quickly and could speed up your claim.
Salimshevan@gmail.com
Do you have children that normally live with you?
Yes
No
Are there any other non-rent paying adults living at the property?
Yes
No
Are there any other adults living in the property who pay rent?
Yes
No
Are you in full time education?
Yes
No
Do you (or your partner if you have one) pay a parental contribution to tuition
fees or a student grant/loan?
Yes
No
Are you in hospital?
Yes
No
Are you in prison?
Yes
No
Are you registered or certified as blind?
Yes
No
Are you receiving support from a carer?
Yes
No

Your circumstances
This section will ask you questions about your income. Please give details of any
income you receive so that we can make an accurate decision on your claim.
Add another earned income|Remove income
Unearned income
Do you receive any of the following?
Income Support, Income based Job Seekers Allowance, Income related
Employment and Support Allowance, Guarantee Pension Credit
Yes
No
Waiting to hear
Do you receive Universal Credit?
Yes
No
Waiting to hear
When did you start receiving Universal Credit?
28/01/2021
How much do you receive? *
1333.64
£
Do you currently receive or are you awaiting a decision on any other unearned
income (e.g. benefits, credits, allowances or pensions)?
Yes
No
Earned income
Are you employed?
Yes
No
Are you self employed?
Yes
No

About your partner
Please provide details about your partner so that we can make a decision on
your claim.
Title
Mrs
Forename(s)
Avin
Surname/family name
Abdula
Date of birth
Day Month Year
05 May 1975
Does your partner have a National Insurance Number?
Yes
No
What is their National Insurance Number?
SK389877B
What is your partner's gender?
Male
Female
When did/will your partner move into this property?
12/12/2021
Is your partner a full time student?
Yes
No
Is your partner in hospital?
Yes
No
Is your partner in prison?
Yes
No
Is your partner registered or certified as blind?
Yes
No
Is your partner receiving support from a carer?
Yes
No
Is your partner a British citizen?
If you are not sure you can check on gov.uk
Yes
No
Is your partner currently in temporary residential accommodation?
Yes
No

Your partner's
circumstances
This section will ask you questions about your partner's income. Please give
details of any income they receive so that we can make an accurate decision on
your claim.
Unearned Income
Do they receive any of the following?
Income Support, Income based Job Seekers Allowance, Income related
Employment and Support Allowance, Guarantee Pension Credit
Yes
No
Waiting to hear
Do they receive Universal Credit?
Yes
No
Waiting to hear
When did they start receiving Universal Credit?
28/01/2021
How much do they receive? *
1333.65
£
Does your partner receive or has your partner applied for any other unearned
income (e.g. benefits, credits, allowances or pensions)?
Yes
No
Earned income
Is your partner employed?
Yes
No
Is your partner self employed?
Yes
No

Capital and savings
Do you have any capital, for example bank accounts, building society accounts,
savings accounts, shares or other investments totalling over £6000? (Note that if
you have a partner this means your total joint capital)
Yes
No
You do not need to tell us about capital if your total (or joint total if you
have a partner) capital is below £6000.
Do you own any property or land in this country or abroad, other than
the property you live in?
(If it is on a mortgage or a loan, still select Yes)
Yes
No
Your partner's capital
Does your partner have any capital, for example bank accounts, building society
accounts, savings accounts, shares or other investments that makes your total
joint capital over £6,000?
Yes
No
You do not need to tell us about your partners capital if your total joint
capital is below £6000.
Does your partner own any other property or land in this country or abroad?
(If it is on a mortgage or a loan, still select Yes)
Yes
No

About your children
Please provide the following information about your children that live with you.
Add another child|Remove child
Child 1
Title
Miss
Forename(s)
Helin
Surname/family name
Salim
Date of birth
Day Month Year
01 November 2007
What is the gender of this child?
Male
Female
What date did/will this child start living at this property?
01/11/2007
Do you receive Child Benefit for this child?
Yes
No
Do you make regular childcare payments?
Yes
No
Is this child in full time education?
Yes
No
Please provide the name of the school that the child attends
Search
Search
Please select the school from the list below
ST BENEDICT RC VOLUNTARY ACADEMY,ST BENEDICTS PER ART COLLEGE,M
Not listed
School name
ST BENEDICT RC VOLUNTARY ACADEMY
School LA code
4607
Does this child receive any disability benefits
Yes
No
Is this child registered or certified blind?
Yes
No

Is this child receiving support from a carer?
Yes
No
Is this child in hospital?
Yes
No
Child 2
Title
Miss
Forename(s)
Daven
Surname/family name
Salim
Date of birth
Day Month Year
11 February 2009
What is the gender of this child?
Male
Female
What date did/will this child start living at this property?
11/02/2009
Do you receive Child Benefit for this child?
Yes
No
Do you make regular childcare payments?
Yes
No
Is this child in full time education?
Yes
No
Please provide the name of the school that the child attends
St benedict
Search
Search
Please select the school from the list below
ST BENEDICT RC VOLUNTARY ACADEMY,ST BENEDICTS PER ART COLLEGE,M
Not listed
School name
ST BENEDICT RC VOLUNTARY ACADEMY
School LA code
4607
Does this child receive any disability benefits
Yes
No
Is this child registered or certified blind?
Yes
No
Is this child receiving support from a carer?

Yes
No
Is this child in hospital?
Yes
No
Child 3
Title
Miss
Forename(s)
Kaven
Surname/family name
Salim
Date of birth
Day Month Year
06 October 2010
What is the gender of this child?
Male
Female
What date did/will this child start living at this property?
06/10/2010
Do you receive Child Benefit for this child?
Yes
No
Do you make regular childcare payments?
Yes
No
Is this child in full time education?
Yes
No
Please provide the name of the school that the child attends
Becket primary school
Search
Search
Your school search returned no results. Please enter the details manually.
School name
Becket primary school
Does this child receive any disability benefits
Yes
No
Is this child registered or certified blind?
Yes
No
Is this child receiving support from a carer?
Yes
No
Is this child in hospital?
Yes
No

Child 4
Title
Mr
Forename(s)
Raben
Surname/family name
Salim
Date of birth
Day Month Year
24 January 2012
What is the gender of this child?
Male
Female
What date did/will this child start living at this property?
24/01/2021
Do you receive Child Benefit for this child?
Yes
No
Do you make regular childcare payments?
Yes
No
Is this child in full time education?
Yes
No
Please provide the name of the school that the child attends
Becket primary school
Search
Search
Your school search returned no results. Please enter the details manually.
School name
Becket primary school
Does this child receive any disability benefits
Yes
No
Is this child registered or certified blind?
Yes
No
Is this child receiving support from a carer?
Yes
No
Is this child in hospital?
Yes
No

Any other information
Use this page to tell us about anything which has not already been mentioned
and which may be useful when we assess this claim.
In order to assess this claim, we may share information with appropriate third
party organisations.
Please tick the box for each third party organisation that you are happy for us to
contact if necessary to assess your claim.
Citizens Advice Bureau
Education authorities
Electoral Registry
Environmental Health bodies
Housing authorities
Your Housing Association
Your landlord
Social Services

Summary

Declaration
Even if someone else has filled in this form for you, please read this
declaration carefully before confirming your acceptance and selecting to
'Submit' your claim.
I declare that the information I have given on this form is correct and complete.
I understand that if I give information that is incorrect or incomplete, you may
take action against me. This may include court action.
I am aware that I must let you know in writing about any change in my
circumstances which might affect my claim. (You may lose benefit if you do not
tell us within one month of that change)
Privacy Notice
We will treat all information provided in confidence and in accordance with our
Privacy Notice. For more information about our Privacy Notice please go to
https://www.derby.gov.uk/privacy-notice/ .
I accept the above terms and conditions. *