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 Orkney Islands Council logo, consisting of a civic crest with the text “ORKNEY ISLANDS COUNCIL”, identifies the council issuing the appeal form.

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