"Application Form for Housing Benefit (Including Local Housing Allowance) and/Or Council Tax Support (Including Second Adult Discount)" - Islington, Greater London, United Kingdom

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Download "Application Form for Housing Benefit (Including Local Housing Allowance) and/Or Council Tax Support (Including Second Adult Discount)" - Islington, Greater London, United Kingdom

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www.islington.gov.uk
Application form for Housing Benefit
(including Local Housing Allowance)
and/or Council Tax Support
(including Second Adult Discount)
If you are on a low income, you could get Housing Benefit to help with your rent. You may also get
Council Tax Support to help pay your Council Tax. The benefits you can apply for are:
Housing Benefit for those that rent from a council or registered social landlord such as a housing
association
Local Housing Allowance for those that rent from a private landlord
‘Second Adult Discount’ is based on the income of other people living with you
Council Tax Support for those who have to pay Council Tax
If you have difficulty making a claim because you are elderly or disabled, we may be able to visit you
at home. Please contact us for help.
Return this form to us straight away or you may lose benefit. Do not delay returning the form
because you are waiting for evidence of earnings or rent. You can send evidence later, but make
sure we receive it within one month or we may not be able to pay you benefit. Make sure your
name and address are on anything you send us later.
You do not need to complete this form if you already have a current claim. If you are reporting a
change in your circumstances please complete a change of circumstances form instead.
Please do not send valuable documents by post.
Islington Customer Centre can photocopy documents for you
www.islington.gov.uk
Application form for Housing Benefit
(including Local Housing Allowance)
and/or Council Tax Support
(including Second Adult Discount)
If you are on a low income, you could get Housing Benefit to help with your rent. You may also get
Council Tax Support to help pay your Council Tax. The benefits you can apply for are:
Housing Benefit for those that rent from a council or registered social landlord such as a housing
association
Local Housing Allowance for those that rent from a private landlord
‘Second Adult Discount’ is based on the income of other people living with you
Council Tax Support for those who have to pay Council Tax
If you have difficulty making a claim because you are elderly or disabled, we may be able to visit you
at home. Please contact us for help.
Return this form to us straight away or you may lose benefit. Do not delay returning the form
because you are waiting for evidence of earnings or rent. You can send evidence later, but make
sure we receive it within one month or we may not be able to pay you benefit. Make sure your
name and address are on anything you send us later.
You do not need to complete this form if you already have a current claim. If you are reporting a
change in your circumstances please complete a change of circumstances form instead.
Please do not send valuable documents by post.
Islington Customer Centre can photocopy documents for you
Look out for the new
TRANSLATIONS SYMBOL
If you see a council publication with the above symbol you
can have that publication explained to you in your own
language, either over the phone at any Islington housing
department office or, in some instances, a translation in
your language can be sent to you.
Part 1
Declaration
Even if someone else has filled in this form for you, you must sign this declaration. If you have a
partner, they must sign this declaration as well. Please read this declaration carefully before you sign
and date it.
I declare and agree with the following.
I declare the information I give on this form is correct and complete.
If I give information that is incorrect or incomplete, you may take action against me. This may also include
prosecuting me or charging fines.
If I am not fully entitled to any benefits declared and this results in you overpaying me benefit, you
may take action against me. This may also include prosecuting me or charging fines.
You will use the information I have provided to process my claim for Housing Benefit, Council Tax Support.
You may check the information I have provided with other sources within the council, other councils and
government agencies. This will include comparing the information I have given to other departments within
the council, other councils and government agencies.
I understand that this form will be held on computer and used to work out my Housing Benefit, Council Tax
Support.
You may use any information I have provided in connection with this and any other claim for social
security benefits, a discretionary housing payment or supported accommodation costs that I have
made or may make. You may give information to other government organisations if the law allows this.
I understand that you may contact the Home Office to check information I have given in this form
and to get any other relevant information.
I know I must let the benefits service know about any changes in my circumstances immediately which
might affect my claim, even if I have already told the DWP or any other organisation. I understand
that if I do not do this you may take action against me. This may include prosecuting me or charging fines.
I understand that you may contact me in writing, by phone, by email or by visiting me at home, for more
information so you can confirm I am still entitled to benefit.
I also understand that if you cannot contact me, you may have to suspend or end my claim.
Where Council Tax Liability ends and there is a credit, the Council may use this credit to reduce any
other sum that is owed to the Council.
Your signature
Date
1.1
/
/
Your partner’s signature
Date
/
/
1
Part 1
Declaration - continued
If someone else has completed
1.2
this form for you, please ask
them to state their full name,
their relationship to you and sign
below to confirm this
Your signature
Date
/
/
I give the person named above permission to act as my representative and to be given information
1.3
about my claim
Your signature
Date
/
/
I give consent for any information regarding my Housing Benefit/Council Tax
No
Yes
1.4
Support claim to be provided to the Council Tax department
I give consent for any information regarding my Housing Benefit/Council Tax
No
Yes
1.5
Support claim to be provided to the Housing department (Council tenants only)
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Evidence you need to send in
You must provide all the evidence we need or we might not be able to award you benefit or support. We
need the same proof for your partner, if you have one, and for any other adults living in your home.
If you don’t have all the evidence we’ve asked for, send in your form immediately, delays may result in
you losing benefit or support. Please tell us what evidence is missing and why you cannot yet provide it.
You must send in any missing evidence within one month of returning your form, stating your name and
address on anything you send us later.
National Insurance number and identity - Original Documents only
We need evidence of your identity (ID) and National Insurance number. If you have a partner, we also need
proof of their National Insurance number and identity.
Please provide one of the documents from each box listed below for you and your partner if you have
one. Remember this must be an original document not a copy.
Documents with a National Insurance number
Latest P45
Current benefit notification letter from the
Latest P60 - within the last two years
Department for Work and Pensions (DWP)
Official wage slips - within the last three
dated within the last 12 months
months, not handwritten
Bank or building society statement showing
Letter from the tax office - dated within the
welfare benefit paid into an account, but this
last 12 months
must quote your National Insurance number
National Insurance number card
If you don’t have any of the above documents to prove your National Insurance number, please provide
one of the following documents as proof of your identity. Remember they must be originals and you should
do the same for your partner if you have one.
Proof of identity
Current EC residence permit
Birth or adoption certificate (original or official
copy of original)
Current Aliens Registration Certificate
Current Immigration and Nationality Directorate
Marriage certificate
Travel Document
Divorce, annulment or separation documents
Full UK driving licence
Bank or building society statement or passbook
updated within the last year
Certificate of employment in HM Forces and
Merchant Navy
Letter from a solicitor, social worker or a
probation officer
Immigration and Nationality Directorate
Standard Acknowledgement Letter (SAL)
Life assurance or life insurance policy
Credit, debit, cheque cards
Medical card
If any of the documents you supply for identity has your name and your partner’s name, we will
accept the document as identity for both of you.
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