Housing Benefit Claim 24pp English Final:Layout 1 01/11/2016 13:03 Page 1 PPhone:hone: 0 165601656 64339 6436436 Bridgend County Borough Council TTeextxt R relay:elay: 1 818001001 (0 1(01656)656) 64 3643643643 PO Box 107 EEmail:mail: b enefiEtsH@QHb¿riWdVg#enEdU.LgGoJvH.uQkGJRYXN Bridgend WWebsite:ebsite: w wwZ.ZbrZidgEeULnGdJ.gHoQvG.uJk RYXN CF31 1WB Name: Reference number: Address: Date issued: / / Postcode: 'DWHRI¿UVWFRQWDFW Claim &foODrLmP IfRoUrP HIoRUu+sRinXgVL QBJe%nHeQfiHt¿, WL/oRcFaDlO H+oRXuVsLQinJg$ AOORllZoDwQaFHnc&eR, XCQoFLuOn7Dc[il5 THaGxX FRWLeRdQu ction, IUHHVFKRROPHDOVDQG'LVWLQFWLYH6FKRRO8QLIRUP*UDQW free school meals and Distinctive School Uniform Grant 3OHDVHWDNHWKHWLPHWRUHDGWKHVHQRWHVRQWKHIURQW DQGEDFNRIHDFKSDJHEHIRUH\RX¿OOLQWKLVIRUP :KDWDUH+RXVLQJ%HQH¿W/RFDO+RXVLQJ$OORZDQFHDQG&RXQFLO7D[5HGXFWLRQ" +RXVLQJ%HQH¿W is help towards paying towards your rent if you rent your home from a housing association or do not qualify for Local Housing Allowance (we will check this for you). /RFDO+RXVLQJ$OORZDQFHLVDUDWHWKDWZHXVHWRZRUNRXW+RXVLQJ%HQH¿WIRU\RXZKHQ\RXUHQW\RXUKRPH from a private landlord. &RXQFLO7D[5HGXFWLRQ is help towards paying your council tax bill. +RZWR¿OOLQWKLVIRUP 6RZHFDQZRUNRXW\RXUEHQH¿WSURSHUO\ZHQHHGWRNQRZDERXW\RXUFLUFXPVWDQFHV:HQHHGWRNQRZ ZKDW\RXULQFRPHLVDQGDQ\VDYLQJV\RXPD\KDYH,I\RXKDYHDSDUWQHUZHQHHGGHWDLOVRIWKHLULQFRPH DQGVDYLQJVWRR:HDOVRQHHGWRNQRZDERXWRWKHUSHRSOHZKROLYHZLWK\RXDQGLI\RXUHQW\RXUKRPH how much rent you pay. Please answer all the questions by ticking either ‘Yes’ or ‘No’ and giving more details when we ask. If you GRQRWDQVZHUDOOWKHTXHVWLRQVZHZLOOKDYHWRZULWHWR\RXWRDVNIRUWKHLQIRUPDWLRQZKLFKPLJKWGHOD\ \RXUEHQH¿W ,IWKHUHLVQRWHQRXJKURRPRQWKHIRUPIRU\RXWRZULWHHYHU\WKLQJWKDW\RXQHHGWRSOHDVHZULWHLQWKH space in section 12 at the back of this form. It will help us if you make it clear which part of the form your information is about. ,I\RXQHHGDQ\DGYLFHDERXWFODLPLQJEHQH¿WRULI\RXKDYHDQ\SUREOHPV¿OOLQJLQWKHIRUPRUJLYLQJXVSURRI SOHDVHFDOOXVRQWKHSKRQHQXPEHUDWWKHWRSRIWKHSDJH<RXDUHDOVRZHOFRPHWRYLVLWXVDW&LYLF2I¿FHV $QJHO6WUHHW%ULGJHQGIRUKHOS:HFDQDOVRVHQGDKRXVLQJRI¿FHUWRVHH\RXLQ\RXUKRPH Use EODFNLQNWR¿OOLQWKLVIRUPDQGVHQGLWEDFNWRXVDVVRRQDV\RXFDQ (YHQLI\RXGRQRWKDYHWKHSURRIZHQHHGDWWKHPRPHQWVHQGWKLVIRUPEDFNWRXV,I\RXZDLW\RX FRXOGORVHEHQH¿W<RXFDQVHQGXVWKHSURRIRULQIRUPDWLRQODWHUEXWSOHDVHPDNHVXUH\RXVHQGRULJLQDO GRFXPHQWV and put your name and address on everything that you send. U011 10/16 8 1 Housing Benefit Claim 24pp English Final:Layout 1 01/11/2016 13:03 Page 2 :KLFKSDUWRIWKHIRUPVKRXOG,¿OOLQ" <RXPXVW¿OOLQDOOV HFWLRQVRIWKHIRUP WRFODLP+RXVLQJ%HQH¿W/RFDO+RXVLQJ$OORZDQFH&RXQFLO7D[ 5HGXFWLRQ+RZHYHULI\RXDUH JHWWLQJ,QF RPH6XSSRUWLQFRPH EDVHG-REVHHNHU¶V$OORZDQFHLQFRPH UHODWHG(PSOR\PHQWDQG6XS SRUW$OORZDQFH RU3HQVLRQ&UHGLW *XDUDQWHHG&UHGLW \RXRQO\QHHGWR¿OO in sections $and 14,I\RXKDYHMXVWDSSOLHGIRURUDUHZDLWLQJWRKHD UEDFNDERXWDQ\RI WKHVHEHQH¿WVWKHQ\RXPXVW¿OOLQDOOVHFWLRQV :KDWSURRIPXVW,JLYH" At the start of some sections is a list of items that you can provide as proof to support the information you give us. These must be R ULJLQDOG RF X PH QW V,I\R XGR QRW SUR YLGHWKHV HG RFXP HQ WVDWWKH VD PHWLPHDV\ RXU IRUP you have one month to get them to us. The one month starts from the day we receive your form. We will try to send your documents back to you within two working days of receiving them. If you do not want to post them to XV\R XFDQ EULQJWKHP WRRX U& XVW RPHU6 HUY LFH&HQWU HDQG & LYLF2I¿FH V$QJ H O6WUH HW %UL GJHQG & ) :% :H DUHRSHQ0RQGD\WR) ULGD \DPWRSPRU\RXFDQWDNHWKHPWRRQHRIWKHLQIRUPDWLRQSRLQWVEH ORZ Q $EHUNHQ¿J/LEUDU\± +HRO/O\IUDX$EHUNHQ¿J%ULGJHQG Q 0DHVWHJ/LEUDU\± 1RUWK¶V/DQH0 DHVWHJ y Q 3HQFRHG/LEUDU\± 3HQ\% RQW5RDG3HQFRHG%ULGJHQG Q 3RUWKFDZO/LEUDU\± &KXUFK3ODFH3RUWKFDZO Age y Q 3\OH/LIH&HQWUH± +HOLJ)DQ3\OH%ULGJHQG Q Age 2JPRUH9DOOH\/LIH &HQWUH±3HQOOZ \QJZHQW2JPRUH9DOH N Age $ERXWVHFWLRQ±&KLOGUHQIUHHVFKRROPHDOVDQG'LVWLQFWLYH6FKRRO N 8QLIRUP*UDQWV 7RJHWIUHHVFKRROPHDOVDQG'LVWLQFWLYHU8nQiLfIoRrUmP G*rUaDnQtWsV fIrUoRmP Y<eHaDrUs 11R,Q pZaDreUGnVts SoDr UgHuQaWVrdRiaUnJsX mDUuGsLDt QVPXVW be receiving one of the following. Q Income Support Q Income-based Jobseeker’s Allowance Q Income-related Employment and Support Allowance No Q 3HQVLRQ&UHGLW *XDUDQWHH&UHGLW Q &KLOG7D[ &UHGLW EXWQRW:RUNLQJ7D[&UHGLW ZLWKDQLQFRPHRIOHVVWKDQ D\HDU No Q Universal Credit $ERXWVHFWLRQ±6WXGHQWV m $VWXGHQWLVVRPHR QHZKRLVRQD FRXUVHDWDVFKRROFROOHJHRUXQLYHUVLW\,I\RXD UH DSDUWWLP HVWXGHQW\RX m FRXOGJHW+RXVLQJ%HQH¿W/RFDO+RX VLQJ$OORZDQFHDQG&RXQFLO7D[5H GXFWLRQV ,I\ RXDUHDIXOOWLPHVWXGH QW m \RXXVXDOO\FDQQRW)XOOWLPHPHDQVWKDW\RXDWWHQGOHVVRQVKRXUVDZHHN,I\RXDUHDIXOOWLPHVWXGHQW \RXFRXOGJHWEHQH¿WLI\RX Q DUHUHFHLYLQJ ,QFRPH6XSSRUWRULQFRPHEDVHD-REVHHNHU¶V$OORZDQFH Q DUHDVLQJ OHSDUHQW Q DQG\RXUSDUWQHUDUHERWKVWXGHQWVDQGDUHUHVSRQVLEOHIRUDFKLOGRUFKLOGUHQ y Q DUHGLVDEOHG Q DUHDJHGRURYHU y Q DUHXQGHUWKHDJ HR IDQG LQIXUWKHUHGXFDWLRQ VWXG\LQJ$/HYHOV%7(&RUDVLPLODUTXDOL¿FDWLRQ Q DUHUHVSRQVLEOHIRUDIRVWHUFKLOGRU / / / / Q a are receiving income-related Employment and Support Allowance. / / / / <RXFRXOGDOVRJHWEHQH¿WLI\ RXUSDUWQHULVDVWXGHQWEXW\RXDUHQRW7KHSHUVRQZKRLVQRWWKHVWXGHQWPXVW a PDNHWKHFODLP,I\RXDUHLQDQ\GRXEWDERXWZKHWKHURUQRW\RXTXDOLI\IRUWKHVHEHQH¿WVSOHDVHFRQWDFWXV EHIRUH¿OOLQJLQWKLVIRUP $ERXW6HFWLRQ±$FFRX QWVVDYLQJVDQGLQYHVWPHQWV ,I\RX\RXUSDUWQHURUERWKRI\RXKDYHVDYLQJVRI RURYHU\RX Z LOOQRWXVXDOO\TXDOLI\IRU+ RX VLQJ %HQH¿W/R FDO+RXVLQJ$OORZDQFH RU&RXQFLO7D[5HGXFWLRQ,I\RXDUHLQDQ\GRXEWDERXWZKHWKHURUQRW\RX TXDOLI\IRUWKHVHEHQH¿WVSOHDVHFRQWDFWXVEHIRUH¿OOLQJLQWKLVIRUP $E RXWVH FWLR Q ± $ER XW \RX UU HQW In section 11 we ask you to tell us about any services you receive that are included as part of your rent VHUYLFHFKDUJHV *HQHUDOO\ZHFDQQRWSD\+RXVLQJ%HQH¿WRU/RFDO+RXVLQJ$OORZDQFHIRUPRVWVHUYLFHV\RX UHFHLYHEXWZHFDQSD\WRZDUGV\RXUVHUYLFHFKDUJHVIRUWKLQJVOLNHKHDWLQJDQGOLJKWLQJLQVKDUHGFRUULGRUV No No 2 Housing Benefit Claim 24pp English Final:Layout 1 01/11/2016 13:03 Page 3 6HFWLRQ$ERXW\RX Please confirm in which language you would prefer us to co ntact you? W elsh English 7KURXJKR XWWK HIRU PZHDV NTX HV WLRQVD ERXW\RXDQ G\RXU SDU WQ HU% \SDUWQHUZH PHD Q DKXVEDQG ZLIHR U FLYLO SDUWQH URU VRPH RQH\ RXOLYH ZL WK DVLIWKH \ZHUH\RXUKXVEDQGZLIHRUFLYLOSDUWQHU $FLYLOSDUWQHULV someone who has entered into a formal agreement (known as a civil partnership) with a same-sex partner so they have the same legal status as a married couple.) <RX <RXUSDUWQHU 7LWOH 0U0UV0V0LVV First names Last name y Previous name or any other name Age youy are known by Age NDate of birth / / Age / / Age NationalN Insurance number <RXGRQRWQHHGWRWHOOXVWKLVEXWLWPD\VSHHG Daytime phone number XS\RXUFODLPLIZHQHHGWRFRQWDFW\RX Email address $UH\RXJHWWLQJ,QFRPH6XSSRUWLQFRPHEDVHG-REVHHNHU¶V$OORZDQFH3HQVLRQ&UHGLW *XDUDQWHH&UHGLW or income-related Employment and SupportNo Allowance? Yes No Q Yes Q No Q Yes Q <RXUKRPH m Do you own your home or pay a mortgage for the house you live in? No Q Yes Q m ,Iµ<HV¶DUH\RXDMRLQWRZQHU" 1RQ Yes Q ,Iµ<HV¶SOHDVHZULWHLQWKHER[ZKR you jointly own your home with. y Have you or your partner moved into yyour home in the last 12 months? No Q*RWRWKHQH[WSDJH<HVQ Please tell us about this below. / <RX / <R/ XUSDUWQ/H U a When did you move into your current / / / / aaddress? If you have not moved in \HWWHOOXVZKHQ\RXH[SHFWWRPRYHLQ (Normally you will not receive +RXVL QJ% HQH¿W RU /RFD O+RXVLQJ $ OORZDQFHXQWLO\RXPRYHLQ What was your or your partner’s last address? If your partner lived at DGLIIHUHQWSUHYLRXVDGGUHVVSOHDVH give us this address too. PPostcode: Postcode: Yes Did you own the property? No Q Yes Q No Q Yes Q Q Q Q Q Did you rent the property? No Yes No Yes 'LG\RXFOD LP+RXVLQJ%HQH¿W/RFDO+NoRX VLQ J$OORZD Q FH RU&RXQFLO7D[5HGXF W LRQ DW\RXYesUSUH YLRXVDGGUHVV" No Q Yes Q No Q Yes Q 3 Housing Benefit Claim 24pp English Final:Layout 1 01/11/2016 13:03 Page 4 <RXULGHQWLW\ We need