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HOUSING BENEFIT/COUNCIL TAX REDUCTION CHANGE OF ADDRESS FORM

Please answer all sections below

Do you have a partner who normally lives with you?

By partner, we mean someone you are married to or live with as if you are married to them. If you have a partner, you must answer all the questions about them, as well as yourself.

  • [ ] No
  • [ ] Yes
YouYour partner
First Names
Surname
Address
Do not tell us your partners address if it is the same as yours
Post Code
Telephone Number
Date of Birth/ // /
National Insurance No

Which benefit do you want to claim

We may need to ask you for more information about this.

  • Housing Benefit (please tick)
  • Council Tax Reduction (please tick)

When did you move to this address?

/ /

If you have not moved in yet, tell us when you expect to move in and confirm this date in writing after you move in.

Have there been any changes in you or your partner's circumstances since your last claim?

You should check your most recent benefit decision letter to see how your claim was assessed.

  • [ ] No
  • [ ] Yes — Please tell us about any changes below. We may need to ask you for more information about this.

Does anyone else live with you and your partner?

  • [ ] No
  • [ ] Yes — Please tell us about these people. We may need to ask you for more information about this.
Full NameRelationship to youDate of BirthIncome type and amount (if over 18)

For office use only

  • Date of issue:
  • Ref:

Have there been any changes in any of these people's circumstances since your last claim for Housing Benefit and/or Council Tax Reduction?

  • [ ] No
  • [ ] Yes

Please tell us about any changes below. We may need to ask you for more information about this.

DECLARATION

Please read this declaration carefully before you sign and date it.

I understand the following: -

If I give information that is incorrect or incomplete, you may take action against me. This may include court action.

  • You will use the information I have provided to process my claim for Housing Benefit or Council Tax Reduction, or both. You may check some of the information with other sources as allowed by the law.
  • You may use any information I have provided in connection with this and any other claim for Social Security benefits that I have made or may make. You may give some information to other departments, local authorities and private-sector companies such as banks and organisations that may lend me money, if the law allows this.

I know I must let the Benefits Section of Orkney Islands Council know about any changes in my circumstances, which might affect my claim. This could be things like where I live, changes in my income or savings, who lives with me, changes in the income of anyone who lives with me, my Income Support or Jobseekers Allowance stopping, if I or my partner go into hospital, or the amount that I pay for my rent.

I declare the information I have given is correct and complete.
Claimant's Signature
Date

If this form has been filled in by someone other than the person claiming:

Please tell us why you are filling in this form

As far as possible, I have confirmed with the person claiming that the answers I have written on the form are correct.
Name of the person who filled in the form
Signature of the person
Relationship to the person claiming
Date

Return this completed form to:

Corporate Services - Benefits Section, School Place, Kirkwall, Orkney, KW15 1NY

If you have any queries you can contact us by telephone on (01856) 886312 or (01856) 873535 Extension 2116 or by email at benefits@orkney.gov.uk

The information on this form may also be used to assess possible entitlement to Council Tax Discount.

Version June 2013

IMAGE: Page 1 shows the Orkney Islands Council form headed “HOUSING BENEFIT/COUNCIL TAX REDUCTION CHANGE OF ADDRESS FORM”. It contains fields for the claimant and partner, benefit-selection checkboxes for Housing Benefit and Council Tax Reduction, questions about changes of circumstances and other household members, and a table headed “Full Name”, “Relationship to you”, “Date of Birth”, and “Income type and amount (if over 18)”. The page also includes an “For office use only” box with “Date of issue” and “Ref”.

IMAGE: Page 2 continues the same form with the question “Have there been any changes in any of these people's circumstances since your last claim for Housing Benefit and/or Council Tax Reduction?”, followed by the “DECLARATION” section, signature and date fields, fields for a person completing the form on someone else’s behalf, the return address for Corporate Services - Benefits Section, telephone contact details, the email address benefits@orkney.gov.uk, and the statement “The information on this form may also be used to assess possible entitlement to Council Tax Discount”.