Tell us about a change in circumstances 1Using the form2Declaration3About you (the claimant)4About the change This form will ask you to provide your details including date of birth and National Insurance number details of the change and the date it occurred proof of the change, if applicable. Please have this information ready as pages time-out after one hour. Do not use your browser back button – if you need to go to a previous page click on the previous button at the bottom of each page. Privacy Statement Dover District Council is a Data Controller under GDPR. In submitting this form we will collect and process your personal data. For information about your rights and how the Council uses your data, please view our Corporate and relevant service privacy notice which can be found on our Privacy Page. DeclarationAre you filling in this form for you or on behalf of someone else?(Required) I am filling in this form for me I am filling in this form on behalf of someone else Please check the box below to confirm that you have read, understand and agree to the following statements before completing this form: I confirm the details I will give are correct and true. I understand that if I give information that is false this could lead to a penalty or legal proceedings being taken against me. I agree that you will use the information I have provided to process my claim for Housing Benefit or Council Tax Support, or both. You may check some of the information with other sources as allowed by the law. I understand that 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 organisations, such as government departments, local authorities and private-sector companies such as banks and organisations that may lend me money, where the law allows this. I know that I must tell you straight away in writing about any change in my circumstances which might affect my claim. This field is hidden when viewing the form Please check the box below to confirm that you have read, understand and agree to the following statements before completing this form: As far as possible, I will confirm with the person claiming that the answers I will give on this form are correct and that the documents I will upload as proof are original copies and have not been edited in any way. I understand that if I give information that is false this could lead to a penalty or legal proceedings being taken against me. I understand my data may be shared with other departments as permitted by law. This field is hidden when viewing the formDeclaration(Required) I understand and accept the above declarationWe will not be able to discuss the claim with the person who is completing the form on the claimant’s behalf unless they provide written permission to do so, unless you are already an appointee, have lasting power of attorney or are a court appointed deputy.I am filling in this form on behalf of(Required)As they cannot fill in the form because(Required)Is the claimant aware that you are completing this form on their behalf? Yes No Full name of the person completing this form(Required)Relationship to the person claiming(Required)Contact email address or phone number(Required)We might need to contact you to check the information you’ve given us About you (the claimant)What support or benefit are you receiving?(Required)Please select all that apply Council Tax Support Housing Benefit Benefit claim reference numberCouncil Tax account numberTitle (for example Mr, Mrs, Ms, Miss)(Required)First name(Required)Last name(Required)Contact phone number(Required)Please provide a mobile number if you have one as we are now using text messaging (SMS) to contact some of our residents.Email address(Required)We will use your email address to send the receipt of your form, including the form reference number. This may include personal data. We will also use your email address to contact you about your Council Tax account and/or benefits. Enter email address Confirm email address Date of birth(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920National Insurance number(Required)About your addressAddress(Required)If you are renting a room include the room number Address line 1 Address line 2 Town or city Postcode About the change in your circumstancesIf you have more than one, please tell us about each one separately and provide the date each change occurred. If you have evidence of the change in your circumstances you can upload copies of it with this form. Please let us know if your email or phone number has changed. About the first changeDate the change occurred? (1)(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What has changed? (1)(Required)Upload proof of this change (1) Drop files here or Select files Max. file size: 6 MB, Max. files: 3. Are you pension age?(Required)For Housing Benefit and Council Tax Support pension age means anyone who has reached the qualifying age for Pension Credit. Yes No Do you have a total household capital of £5,500 or more?(Required) Yes No Do you have a household capital of £9,500 or more?(Required) Yes No Do you have another change to tell us about?(Required) Yes No About the second changeDate the change occurred? (2)(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What has changed? (2)(Required)Upload proof of this change (2) Drop files here or Select files Max. file size: 6 MB, Max. files: 3. Do you have another change to tell us about? (2)(Required) Yes No About the third changeDate the change occurred? (3)(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What has changed? (3)(Required)Upload proof of this change (3) Drop files here or Select files Max. file size: 6 MB, Max. files: 3. Do you have another change to tell us about? (3)(Required) Yes No About the fourth changeDate the change occurred? (4)(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What has changed? (4)(Required)Upload proof of this change (4) Drop files here or Select files Max. file size: 6 MB, Max. files: 3. Do you have any other changes to tell us about? (4)(Required) Yes No About any other changesPlease tell us about any other changes(Required)Enter the information and then click on the + sign to add another row for each additional change you have.Date the change occurred? (dd/mm/yyyy)What has changed? Add RemoveUpload proof of these changes (other) Drop files here or Select files Max. file size: 6 MB, Max. files: 3. About the changesApart from the change(s) declared there are no other changes in my circumstances and the information you currently hold is correct.(Required) I confirm the above
