Housing Benefit and Council Tax Reduction Appeal form
You should only complete this form if you wish to appeal against your Housing Benefit and/or Council Tax Reduction.
IMAGE: The upper-right corner shows the Orkney Islands Council crest and the words “ORKNEY ISLANDS COUNCIL”.
Part 1 About you
Last name
Other names
Title
Mr, Mrs,Ms etc
Address
Postcode
Date of birth
//____
National Insurance number
Letters: __
Numbers: ___
Letter: _
Your daytime telephone number
Have you arranged for someone to help with your appeal?
- [ ] No — Go to Part 2
- [ ] Yes — Please give their name and address
Their full name
Their address
Postcode
Sign this box to authorise this person to act for you.
Part 2 About the decision
Name of benefit you wish to appeal against.
Please tick:
- [ ] Housing Benefit
- [ ] Council Tax Reduction
- [ ] Both
Date of decision being appealed against.
//____
This can be found at the top of the letter about the decision.
Part 3 About your appeal
Use this box to tell us why you do not agree with the decision.
You must tell us why you think the decision is wrong. It is not enough to say ‘I do not agree with the decision’ or ‘The benefit is not enough’.
If you have appealed against more than one decision, you must say why you do not agree with each one.
Are you appealing more than one month after the decision was made?
- [ ] No
- [ ] Yes — Please tell us why your appeal has been delayed.
Part 4 Your signature
Your signature
Date
//____
If someone has been officially appointed to act for you or someone has the authority to act for you, they should sign here.
Part 5 What to do now
- Make sure you have signed this form.
- Take or send this form to The Benefits Section, Corporate Services, Orkney Islands Council, Council Offices, Kirkwall KW15 1NY.
Form reviewed - Nov 13
AP 1