Applicant and partner details
If you do not give correct information you may be prosecuted
This form should be completed if your Housing Benefit and/or Council Tax Reduction claim has been cancelled, because the review information we had requested was not provided at the appropriate time .
If you haven't done so already you must provide all of the information we have previously requested, or we cannot reconsider your claim.
If you are going to upload multiple documents, please ensure they have a meaningful file name such as Bank Statement Oct 2016, Bank Statement Nov 2016 etc, otherwise we may have to request the information again.
Supporting evidence and information can be uploaded at the end of this form.
Your title Please select Mr Mrs Miss Ms Mx Doctor Professor Reverend Councillor Rabbi Sister Other
Your first name
Your last name
Your national insurance number, in the format AB123456C
Your email address
If you include an email address a copy of this form will be emailed to you.
Your daytime contact telephone number. Please include the area code.
You must enter the postcode and search for your address before you can proceed.
Select the address from this list No properties found or searched for
The full postal address of where you are claiming the reconsideration.
Your benefit claim reference number as shown on your award letters
Please input the correct housing benefit claim reference number as it will help us to process this form more quickly.
If other, please give full details
Name and full postal address of your private landlord or their letting agent
How much is your rent for the chosen period
If yes , you must upload details of the change in your rent
Name and full postal address of your housing association
How much is your rent for the chosen period
If yes , you must upload details of the change in your rent
We need to know if you have a partner .
By partner we mean
a person you are married to or a person you live with as if you are married to them, or
a civil partner or person you live with as if you are civil partners.
Your partner's title Please select Mr Mrs Miss Ms Mx Doctor Professor Reverend Councillor Rabbi Sister Other
Your partner's first name
Your partner's last name
Your partner's national insurance number, in the format AB123456C
We need to know if you and/or your partner are in work.
Where either you and/or your partner are working you will need to provide proof of your earnings.
The last five weeks payslips if you are paid weekly
The last three consecutive payslips if you are paid fortnightly
The last two consecutive payslips if you are paid four weekly or monthly
If you and/or your partner are self employed, we will contact you about this separately.
We will contact you separately about your self employed earnings
Name and full postal address of your employer
How much do you get paid every week
How much are you paid forthnightly (2 weekly)
How much are you paid every 4 weeks
How much are you paid monthly
We will contact you separately about your self employed earnings
Name and full postal address of your partner's employer
How much is your partner paid every week
How much is your partner paid forthnightly (2 weekly)
How much is your partner paid every four weeks
How much is your partner paid monthly
Benefits, allowances and tax credits
Please give details of all the benefits, allowances and tax credits that you receive, how often it is received (e.g. weekly, four weekly, monthly etc.), and when you started to receive it
This can include
Contributions-based Job Seekers Allowance
Universal Credit
Maternity Allowance
Child Benefit/Child Benefit (Lone parent
Working Tax Credit
Child Tax Credit
Widowed Mothers Allowance
Contribution-based Employment and Support Allowance
Incapacity Benefit-long term rate
Incapacity Benefit-short-term higher rate
Incapacity Benefit-short-term lower rate
Disability Living Allowance-Care component
Disability Living Allowance-Mobility component
Personal Independence Payment-Daily Living component
Personal Independence Payment-Mobility component
Attendance Allowance
Severe Disablement Allowance
Carers Allowance
Industrial Injury or Disability Benefit
Government training schemes
New Deal Training Allowance
Any other benefit or allowance not listed above
You can upload copies of documents at the end of this form.
If you are going to upload multiple documents, please ensure they
have a meaningful file name such as Income Support award letter Nov 2016, Universal Credit award letter Oct 2016 etc, otherwise we may have to request the information again.
Benefits and allowances table guidance
Please enter the "Type" of benefit such as Universal Credit, the amount received, such as £100.00, how often it is received and who it is received by, and then use the Add button.
The Add button will upload the first row of data and create a new row where you can then then enter the details of any other benefits or allowances received by you or your partner.
Please remember to use the Add button when you have entered the details for each additional benefit or allowance. If you don't, the details won't be added to the form and it will delay your application.
You must also provide evidence of all the benefits or allowances you are claiming.
Documents can be uploaded at the end of this form
Other income
Please give details of all other income received.
This can include:
Maintenance payments
Education Grants
Foster Allowance
Guardians Allowance
Adoption or Custodian Allowance
Income from rent
Money from boarders (including Housing Benefit payments you receive from boarders)
Money from subtenants (heating provided)
Money from subtenants (heating not provided)
Money instead of concessionary coal
Any other income you may receive that is not listed above
We need to see proof of any income that has changed since your last claim.
You can upload copies of documents at the end of this form.
If you are going to upload multiple documents, please ensure they
have a meaningful file name such as Maintenance payments Nov 2016, Education Grant Sept 2016 etc, otherwise we may have to request the information again.
Other income table guidance
Please enter the "Type" of income such as Child or Working Tax Credits, the amount received, such as £100.00, how often it is received and who it is received by, and then use the Add button.
The Add button will upload the first row of data and create a new row where you can then then enter the details of any other income received by you or your partner.
Please remember to use the Add button when you have entered the details for each additional income. If you don't, the details won't be added to the form and it will delay your application.
You must also provide evidence of all the other income you are receiving.
Documents can be uploaded at the end of this form
Savings, capital and investments
We need proof of all bank and building society accounts (last two statements or one statement covering at least two months transactions) savings and investments you and your partner have.
Documents can be uploaded at the end of this form.
If you are going to upload multiple documents, please ensure they have a meaningful file name such as Bank Statement Oct 2016, Bank Statement Nov 2016 etc, otherwise we may have to request the information again.
If yes, how much do you have saved, for example £200.00
Savings, capital and investments table guidance
Please enter the "Type" such as bank account shares etc, the details of account held, such as Current a/c, savings a/c, ISA etc, and the amount in each account such as £500.00, and then use the Add button.
The Add button will upload the first row of data and create a new row where you can then then enter the details of any other savings, capital or investments you or your partner have.
Please remember to use the Add button when you have entered the details for each additional savings, capital or investments. If you don't, the details won't be added to the form and it will delay your application.
You must also provide evidence of all the savings, capital and investments you have.
Documents can be uploaded at the end of this form
If yes, please confirm the total amount held, such as £100.00
If yes, please confirm the issue number, issue date and the units held and values
If yes, please confirm the name of the company and the number of shares held
If yes, please confirm the name of the company or unit manager and the number owned
If yes , we will write to you again for more details
If yes, please give full details below
If yes, please give full details below
