Orkney Islands Council

Housing Benefit

Application for benefit on two homes

IMAGE: The form includes the Orkney Islands Council crest in the upper-right corner, with the text “ORKNEY ISLANDS COUNCIL”. It contains blank fields for the applicant’s details, addresses, dates, reasons for moving, rental liability information, declaration, signature, and date.

Your name:

Your date of birth:

National Insurance Number:

Your address:

Daytime phone number:

When did you move to your new address?

What date was the tenancy offered?

Are there any special reasons why you needed to move into this particular house?

Why were you unable to avoid a rental liability on two properties?

Your previous address:

When did you give notice to your landlord?

What date have you been charged rent to at your previous address? (We will need to see proof of the date your rent has been charged to at your previous address; please provide a letter from your landlord confirming this information).

Declaration - The information that I have given are true and complete as far as I know. I know if I deliberately give false information, action can be taken against me.

Your Signature:

Date:

Please return the completed form to: Benefits Section, Orkney Islands Council, School Place, Kirkwall, KW15 1NY. Tel: 01856 886312: email: benefits@orkney.gov.uk

Website: www.orkney.gov.uk

December 2013