Apply for Council Tax Support

1Using the form

2Declaration

3About you

4About you (continued)

5About your living situation

6About your partner

7About any children who live with you

8About any other people who live with you

9About any benefits

10About any capital

11About the award start date

12About any proof and other information

This form is to apply for Council Tax Support.

Anyone can apply for help with council tax but you will only get help if you have a low income.

It is important to provide accurate details of your income and capital so that the correct award of Council Tax Support can be made.

You can ask for your claim to be backdated by up to three months. If you want to do this you’ll need to provide evidence when you apply showing your income and personal circumstances during the period you want it backdated to.

Capital limits
If your capital is above the amount below you will not be entitled to any Council Tax Support.

If you are working age, or treated as being working age the capital limit is £6,000.
If you are pension age, the capital limit is £16,000.

This form will ask you to provide

your details including National Insurance number
details of any adults or children who normally live with you
details of any benefits and other income you receive
details of your capital
proof to support your application for example, proof of identity, proof of National Insurance number

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.

Declaration

Are 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

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

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 form

Declaration(Required)

I understand and accept the above declaration

We 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

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

This field is hidden when viewing the form

About Universal Credit

This field is hidden when viewing the form

Are you currently receiving Universal Credit?(Required)

Yes, I am currently receiving Universal Credit

No, I am not receiving Universal Credit

This field is hidden when viewing the form

Not receiving Universal Credit

You need to apply for Council Tax Support. Make a claim for Council Tax Support

About you (the claimant)

Benefit reference number

Title (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

Would you like to receive your Council Tax bills by email?(Required)

You can receive your Council Tax bills and benefit notifications by email rather than post. We will send all future Council Tax bills and benefit notifications to the email address you have given above. This service is only available to people who are named on the bill. If you change your email address you must let us know straight away. You can opt out of this at any time at dover.gov.uk/paperless.

Yes

Date of birth(Required)

Day

Month

Year

National Insurance number(Required)

Nationality(Required)

About your address

Address(Required)

If you are renting a room include the room number

Address line 1 Address line 2 Town or city Postcode

What date did you move into this address?(Required)

Day

Month

Year

About you (the claimant) continued

Are you a full time student?(Required)

Yes

Have you already provided a copy of your student certificate?(Required)

Yes

Upload a copy of your current student certificate

If you do not have it available at the moment you can provide it later.

Drop files here or

Max. file size: 1 MB.

Are you an apprentice?(Required)

If you or someone living with you is an apprentice, and without them there is only one adult living in your home, you can apply for an apprentice discount.

Yes

Are you severely mentally impaired?(Required)

If everyone living in a property is severely mentally impaired you can apply for an exemption (which means you don’t have to pay Council Tax for the property). If someone living with you is severely mentally impaired and without them there is only one adult living in your home, you can apply for a 25% discount on your Council Tax. You can apply for a severely mentally impaired discount or exemption.

Yes

Are you registered blind?(Required)

Yes

Does anyone get Carer's Allowance or the carer's element of Universal Credit for looking after you?(Required)

Yes

Are you temporarily living away from home?(Required)

Yes

When did you start living away from home?(Required)

Day

Month

Year

Where are you temporarily living and why?(Required)

Such as hospital, on remand, if abroad specify the country you are visiting

When do you expect to return home?(Required)

About your living situation

Do you live on your own?(Required)

Yes

This field is hidden when viewing the form

Do you have a partner living with you?(Required)

By partner we mean a person you are married to or a person you live with as if you are married to them or a civil partner or a person you live with as if you are civil partners.

Yes

This field is hidden when viewing the form

Do you have any children who normally live with you?(Required)

A child for this question is any child you are or could receive Child Benefit for. So they would be aged under 16, aged 16 or 17 and registered for work or youth training or aged 16 to 19 and in education on a course not higher than GCE A-Level, SCE Higher Level, or GNVQ advanced.

Yes

This field is hidden when viewing the form

Do you have any other people who live with you (other than your partner if you have one)?(Required)

An adult is anyone over the age of 16 that you do not receive Child Benefit for. This includes other family and friends, boarders, subtenants and lodgers. Include any children they have who live in your household. Don’t tell us about people who just share a hall, bathroom and/or toilet.

Yes

About your partner who lives with you

By partner we mean:

a person you are married to or a person you live with as if you are married to them or
a civil partner or a person you live with as if you are civil partners

Please provide the following information about your partner:

Title (for example Mr, Mrs, Ms, Miss) (partner)(Required)

First name (partner)(Required)

Last name (partner)(Required)

Contact phone number (partner)

Email address (partner)

Enter email address Confirm email address

Date of birth (partner)(Required)

Day

Month

Year

National Insurance number (partner)

Nationality (partner)

Are they a full time student? (partner)(Required)

Yes

Have they already provided a copy of their student certificate? (partner)(Required)

Yes

Upload a copy of their current student certificate (partner)

If you do not have it available at the moment you can provide it later.

Drop files here or

Max. file size: 1 MB.

Are they an apprentice? (partner)(Required)

If you or someone living with you is an apprentice, and without them there is only one adult living in your home, you can apply for an apprentice discount.

Yes

Are they severely mentally impaired? (partner)(Required)

Yes

Are they registered blind? (partner)(Required)

Yes

Does anyone get Carer's Allowance or the carer's element of Universal Credit for looking after your partner?(Required)

Yes

Are they temporarily living away from home? (partner)(Required)

Yes

When did they start living away from home? (partner)(Required)

Day

Month

Year

Where are they temporarily living and why? (partner)(Required)

Such as hospital, on remand, if abroad specify the country they are visiting.

When do you expect them to return home? (partner)(Required)

About the children who live with you

We need to know about any children who normally live with you and/or who you or your partner get, or have applied for, Child Benefit for.

A child is:

aged under 16
aged 16 or 17 and registered for work or youth training, or
aged 16 to 19 and in education on a course not higher than GCE A-Level, SCE Higher Level, or GNVQ advanced

About the first child

Full name (child 1)(Required)

Date of birth (child 1)(Required)

Day

Month

Year

Gender (child 1)

Do you or your partner receive Child Benefit for this child? (1)(Required)

Yes

How much Child Benefit do you receive for this child? (1)(Required)

Have you applied for Child Benefit for this child? (1)(Required)

Yes

Who receives child benefit for this child? (1)(Required)

Name of the person receiving the child benefit (1)

Relationship to this child (1)

Number of hours this child spends with them each week (1)

Is this child registered blind? (1)(Required)

Yes

Has this child been formally placed with you for fostering? (1)(Required)

Yes

Does this child receive any benefits for disability such as Personal Independence Payment or Disability Living Allowance? (1)(Required)

Yes

What benefit(s) does this child receive? (1)(Required)

What is their National Insurance number? (1)

Do you or your partner pay any childminding costs for this child to a registered childminder, a nursery or an after-school club? (1)(Required)

If ‘Yes’ we may need additional evidence about this depending on your other circumstances

Yes

Is there another child who lives with you? (1)(Required)

Yes

About the second child

Full name (child 2)(Required)

Date of birth (child 2)(Required)

Day

Month

Year

Gender (child 2)(Required)

Do you or your partner receive Child Benefit for this child? (2)(Required)

Yes

How much Child Benefit do you receive for this child? (2)(Required)

Have you applied for Child Benefit for this child? (2)(Required)

Yes

Who receives child benefit for this child? (2)(Required)

Name of the person receiving the child benefit (2)

Relationship to this child (2)

Number of hours this child spends with them each week (2)

Is this child registered blind? (2)(Required)

Yes

Has this child been formally placed with you for fostering? (2)(Required)

Yes

Does this child receive any benefits for disability such as Personal Independence Payment or Disability Living Allowance? (2)(Required)

Yes

What benefit(s) does this child receive? (2)(Required)

What is their National Insurance number? (2)

Do you or your partner pay any childminding costs for this child to a registered childminder, a nursery or an after-school club? (2)(Required)

If ‘Yes’ we may need additional evidence about this depending on your other circumstances

Yes

Is there another child who lives with you? (2)(Required)

Yes

About the third child

Full name (child 3)(Required)

Date of birth (child 3)(Required)

Day

Month

Year

Gender (child 3)(Required)

Do you or your partner receive Child Benefit for this child? (3)(Required)

Yes

How much Child Benefit do you receive for this child? (3)(Required)

Have you applied for Child Benefit for this child? (3)(Required)

Yes

Who receives child benefit for this child? (3)(Required)

Name of the person receiving the child benefit (3)

Relationship to this child (3)

Number of hours this child spends with them each week (3)

Is this child registered blind? (3)(Required)

Yes

Has this child been formally placed with you for fostering? (3)(Required)

Yes

Does this child receive any benefits for disability such as Personal Independence Payment or Disability Living Allowance? (3)(Required)

Yes

What benefit(s) does this child receive? (3)(Required)

What is their National Insurance number? (3)

Do you or your partner pay any childminding costs for this child to a registered childminder, a nursery or an after-school club? (3)(Required)

If ‘Yes’ we may need additional evidence about this depending on your other circumstances

Yes

Is there another child who lives with you? (3)(Required)

Yes

About the fourth child

Full name (child 4)(Required)

Date of birth (child 4)(Required)

Day

Month

Year

Gender (child 4)(Required)

Do you or your partner receive Child Benefit for this child? (4)(Required)

Yes

How much Child Benefit do you receive for this child? (4)(Required)

Have you applied for Child Benefit for this child? (4)(Required)

Yes

Who receives child benefit for this child? (4)(Required)

Name of the person receiving the child benefit (4)

Relationship to this child (4)

Number of hours this child spends (4)with them each week (4)

Is this child registered blind? (4)(Required)

Yes

Has this child been formally placed with you for fostering? (4)(Required)

Yes

Does this child receive any benefits for disability such as Personal Independence Payment or Disability Living Allowance? (4)(Required)

Yes

What benefit(s) does this child receive? (4)(Required)

What is their National Insurance number? (4)

Do you or your partner pay any childminding costs for this child to a registered childminder, a nursery or an after-school club? (4)(Required)

If ‘Yes’ we may need additional evidence about this depending on your other circumstances

Yes

Is there another child who lives with you? (4)(Required)

Yes

About the fifth child

Full name (child 5)(Required)

Date of birth (child 5)(Required)

Day

Month

Year

Gender (child 5)(Required)

Do you or your partner receive Child Benefit for this child? (5)(Required)

Yes

How much Child Benefit do you receive for this child? (5)(Required)

Have you applied for Child Benefit for this child? (5)(Required)

Yes

Who receives child benefit for this child? (5)(Required)

Name of the person receiving the child benefit (5)

Relationship to this child (5)

Number of hours this child spends with them each week (5)

Is this child registered blind? (5)(Required)

Yes

Has this child been formally placed with you for fostering? (5)(Required)

Yes

Does this child receive any benefits for disability such as Personal Independence Payment or Disability Living Allowance? (5)(Required)

Yes

What benefit(s) does this child receive? (5)(Required)

What is their National Insurance number? (5)

Do you or your partner pay any childminding costs for this child to a registered childminder, a nursery or an after-school club? (5)(Required)

If ‘Yes’ we may need additional evidence about this depending on your other circumstances

Yes

Is there another child who lives with you? (5)(Required)

Yes

About the sixth child

Full name (child 6)(Required)

Date of birth (child 6)(Required)

Day

Month

Year

Gender (child 6)(Required)

Do you or your partner receive Child Benefit for this child? (6)(Required)

Yes

How much Child Benefit do you receive for this child? (6)(Required)

Have you applied for Child Benefit for this child? (6)(Required)

Yes

Who receives child benefit for this child? (6)(Required)

Name of the person receiving the child benefit (6)

Relationship to this child (6)

Number of hours this child spends with them each week (6)

Is this child registered blind? (6)(Required)

Yes

Has this child been formally placed with you for fostering? (6)(Required)

Yes

Does this child receive any benefits for disability such as Personal Independence Payment or Disability Living Allowance? (6)(Required)

Yes

What benefit(s) does this child receive? (6)(Required)

What is their National Insurance number? (6)

Do you or your partner pay any childminding costs for this child to a registered childminder, a nursery or an after-school club? (6)(Required)

If ‘Yes’ we may need additional evidence about this depending on your other circumstances

Yes

Is there another child who lives with you? 6(Required)

Yes

About any other children

Please provide the following information for any other children who live with you:

Full name
Date of birth
Gender
Do you or your partner receive Child Benefit for this child? If Yes, how much?
Is this child registered blind?
Has this child been formally placed with you for fostering?
Does this child receive any benefits for disability such as Personal Independence Payment or Disability Living Allowance? If Yes, what benefits and what is their National Insurance number?

Please tell us about any other children(Required)

About the other people who live with you

Please tell us about any other people who live with you. This includes other family and friends, boarders, subtenants and lodgers.

Include any children they have who live in your household.

Tell us about people who are away studying but return for the holidays and after their course.
Tell us about people who are in the armed forces on operations.
Don’t tell us about people who just share a hall, bathroom and/or toilet

About the first other person

Title (for example Mr, Mrs, Ms, Miss) (1)(Required)

First name (1)(Required)

Last name (1)(Required)

Date of birth (1)(Required)

Day

Month

Year

National Insurance number (1)

Are they a joint owner/tenant? (1)(Required)

Yes

What proportion of the rent/council do they pay? (1)(Required)

For example, 25%, half, etc

Do they pay rent or money for board and lodgings to you or your partner? (1)(Required)

Yes

Do they receive any of the following? (1)(Required)

Please select all that apply

Attendance Allowance

Disability Living Allowance – care component

Personal Independence Payment – daily living component

Armed Forces Independence Payment

Income Support

Jobseekers Allowance (income based)

Employment and Support Allowance (income related)

Pension Credit (Guarantee Credit)

Universal Credit calculated without any earned income

Universal Credit calculated with earnings

None of the above

Do they work? (1)(Required)

Yes

How many hours per week do they normally work? (1)(Required)

What is their usual gross weekly earnings? (1)(Required)

Do they receive any other incomes not previously mentioned in addition to their earnings? (1)(Required)

Yes

Please list the other incomes they receive along with the amount normally received each week (person 1)(Required)

Do they fall into any of the following categories? (1)(Required)

Please select all that apply

Care worker

Apprentice

Youth trainee

Severely mentally impaired

In legal custody

In hospital

None of the above

Are they a full time student? (1)(Required)

Yes

Have you already provided a copy of their student certificate? (1)(Required)

Yes

Upload a copy of their current student certificate (1)

If you do not have it available at the moment you can provide it later.

Drop files here or

Max. file size: 1 MB.

Is there another person who lives with you? (1)(Required)

Yes

About the second person

Title (for example Mr, Mrs, Ms, Miss) (2)(Required)

First name (2)(Required)

Last name (2)(Required)

Date of birth (2)(Required)

Day

Month

Year

National Insurance number (2)

Are they a joint owner/tenant? (2)(Required)

Yes

What proportion of the rent/council do they pay? (2)(Required)

For example, 25%, half, etc

Do they pay rent or money for board and lodgings to you or your partner? (2)(Required)

Yes

Do they receive any of the following? (2)(Required)

Please select all that apply

Attendance Allowance

Disability Living Allowance – care component

Personal Independence Payment – daily living component

Armed Forces Independence Payment

Income Support

Jobseekers Allowance (income based)

Employment and Support Allowance (income related)

Pension Credit (Guarantee Credit)

Universal Credit calculated without any earned income

Universal Credit calculated with earnings

None of the above

Do they work? (2)(Required)

Yes

How many hours per week do they normally work? (2)(Required)

What is their usual gross weekly earnings? (2)(Required)

Do they receive any other incomes not previously mentioned in addition to their earnings? (2)(Required)

Yes

Please list the other incomes they receive along with the amount normally received each week (2)(Required)

Do they fall into any of the following categories? (2)(Required)

Please select all that apply

Care worker

Apprentice

Youth trainee

Severely mentally impaired

In legal custody

In hospital

None of the above

Are they a full time student? (2)(Required)

Yes

Have you already provided a copy of their student certificate? (2)(Required)

Yes

Upload a copy of their current student certificate (2)

If you do not have it available at the moment you can provide it later.

Drop files here or

Max. file size: 1 MB.

Is there another person who lives with you? (2)(Required)

Yes

About the third person

Title (for example Mr, Mrs, Ms, Miss) (3)(Required)

First name (3)(Required)

Last name (3)(Required)

Date of birth (3)(Required)

Day

Month

Year

National Insurance number (3)

Are they a joint owner/tenant? (3)(Required)

Yes

What proportion of the rent/council do they pay? (3)(Required)

For example, 25%, half, etc

Do they pay rent or money for board and lodgings to you or your partner? (3)(Required)

Yes

Do they receive any of the following? (3)(Required)

Please select all that apply

Attendance Allowance

Disability Living Allowance – care component

Personal Independence Payment – daily living component

Armed Forces Independence Payment

Income Support

Jobseekers Allowance (income based)

Employment and Support Allowance (income related)

Pension Credit (Guarantee Credit)

Universal Credit calculated without any earned income

Universal Credit calculated with earnings

None of the above

Do they work? (3)(Required)

Yes

How many hours per week do they normally work? (3)(Required)

What is their usual gross weekly earnings? (3)(Required)

Do they receive any other incomes not previously mentioned in addition to their earnings? (3)(Required)

Yes

Please list the other incomes they receive along with the amount normally received each week (3)(Required)

Do they fall into any of the following categories? (3)(Required)

Please select all that apply

Care worker

Apprentice

Youth trainee

Severely mentally impaired

In legal custody

In hospital

None of the above

Are they a full time student? (3)(Required)

Yes

Have you already provided a copy of their student certificate? (3)(Required)

Yes

Upload a copy of their current student certificate (3)

If you do not have it available at the moment you can provide it later.

Drop files here or

Max. file size: 1 MB.

Is there another person who lives with you? (3)(Required)

Yes

About the fourth person

Title (for example Mr, Mrs, Ms, Miss) (4)(Required)

First name (4)(Required)

Last name (4)(Required)

Date of birth (4)(Required)

Day

Month

Year

National Insurance number (4)

Are they a joint owner/tenant? (4)(Required)

Yes

What proportion of the rent/council do they pay? (4)(Required)

For example, 25%, half, etc

Do they pay rent or money for board and lodgings to you or your partner? (4)(Required)

Yes

Do they receive any of the following? (4)(Required)

Please select all that apply

Attendance Allowance

Disability Living Allowance – care component

Personal Independence Payment – daily living component

Armed Forces Independence Payment

Income Support

Jobseekers Allowance (income based)

Employment and Support Allowance (income related)

Pension Credit (Guarantee Credit)

Universal Credit calculated without any earned income

Universal Credit calculated with earnings

None of the above

Do they work? (4)(Required)

Yes

How many hours per week do they normally work? (4)(Required)

What is their usual gross weekly earnings? (4)(Required)

Do they receive any other incomes not previously mentioned in addition to their earnings? (4)(Required)

Yes

Please list the other incomes they receive along with the amount normally received each week (4)(Required)

Do they fall into any of the following categories? (4)(Required)

Please select all that apply

Care worker

Apprentice

Youth trainee

Severely mentally impaired

In legal custody

In hospital

None of the above

Are they a full time student? (4)(Required)

Yes

Have you already provided a copy of their student certificate? (4)(Required)

Yes

Upload a copy of their current student certificate (4)

If you do not have it available at the moment you can provide it later.

Drop files here or

Max. file size: 1 MB.

Is there another person who lives with you? (4)(Required)

Yes

About any other people who live with you

Please provide the following information for any other people who live with you:

Full name
Date of birth
National Insurance number
Are they a joint owner/tenant? if Yes what proportion of the rent/council do they pay?
Do they pay rent or money for board and lodgings to you or your partner?
Do they receive any Allowance or Independence payments?
Do they work? If Yes, how many hours?
Are they a: Full time student, care worker, apprentice, youth trainee severely mentally impaired, in legal custody or in hospital?

Please tell us about any other people(Required)

About any other people who live with you (continued)

Do any of the other people listed live together as a couple?(Required)

Yes

Please tell us the full names of the couples(Required)

Please list all the full names of the couples. Enter the full name and then click on the + sign to add another row for each couple.

Full name – is the partner of

Full name

About any other benefits or household income you (or your partner if you have one) receive

Do you (or your partner if you have one) receive any of the following?(Required)

Income Support

Jobseekers Allowance (income based)

Employment and Support Allowance (income related)

Pension Credit (Guarantee Credit)

Pension Credit (Savings Credit only)

Universal Credit

None of the above

Is your capital currently below £16,000?(Required)

Yes

Earnings/self employment

Are you or your partner self-employed?(Required)

Select ‘No’ if you are a company director

Yes

As you or your partner is self-employed you will need to provide additional information, please also complete a Housing benefit and council tax support self-employed income form. The form link will also be provided at the end of this form.

Do you or your partner do any work for an employer?(Required)

Yes

About the first job

Please answer the following questions about the first job

Who is employed in this job? (1)(Required)

I am employed in this job

My partner is employed in this job

Name of the employer (1)(Required)

Address of the employer (1)(Required)

Payroll, employee or staff number (1)(Required)

Date you or your partner started this job (1)(Required)

Day

Month

Year

If this job is due to end soon please tell us the date (1)

Day

Month

Year

How many hours each week do you or your partner usually work? (1)(Required)

How often are the wages paid? (1)(Required)

How much are you or your partner normally paid in a typical payslip? (1)(Required)

Gross £

Tax deducted £

National Insurance deducted £

Pension contribution deducted £

Are you or your partner getting Statutory Sick Pay, Maternity Pay, Paternity Pay or Adoption Pay from this employer? (1)(Required)

Yes

When do you expect to return to this job? (1)

Day

Month

Year

Do you or your partner have any other jobs (1)(Required)

Yes

About the second job

Please answer the following questions about the second job

Who is employed in this job? (2)(Required)

I am employed in this job

My partner is employed in this job

Name of the employer (2)(Required)

Address of the employer (2)(Required)

Payroll, employee or staff number (2)(Required)

Date you or your partner started this job (2)(Required)

Day

Month

Year

If this job is due to end soon please tell us the date (2)

Day

Month

Year

How many hours each week do you or your partner usually work? (2)(Required)

How often are the wages paid? (2)(Required)

How much are you or your partner normally paid in a typical payslip? (2)(Required)

Gross £

Tax deducted £

National Insurance deducted £

Pension contribution deducted £

Are you or your partner getting Statutory Sick Pay, Maternity Pay, Paternity Pay or Adoption Pay from this employer? (2)(Required)

Yes

When do you expect to return to this job? (2)

Day

Month

Year

Do you or your partner have any other jobs (2)(Required)

Yes

About the third job

Please answer the following questions about the third job

Who is employed in this job? (3)(Required)

I am employed in this job

My partner is employed in this job

Name of the employer (3)(Required)

Address of the employer (3)(Required)

Payroll, employee or staff number (3)(Required)

Date you or your partner started this job (3)(Required)

Day

Month

Year

If this job is due to end soon please tell us the date (3)

Day

Month

Year

How many hours each week do you or your partner usually work? (3)(Required)

How often are the wages paid? (3)(Required)

How much are you or your partner normally paid in a typical payslip? (3)(Required)

Gross £

Tax deducted £

National Insurance deducted £

Pension contribution deducted £

Are you or your partner getting Statutory Sick Pay, Maternity Pay, Paternity Pay or Adoption Pay from this employer? (3)(Required)

Yes

When do you expect to return to this job? (3)

Day

Month

Year

Do you or your partner have any other jobs (3)(Required)

Yes

About any other jobs

Please provide the following information for any other employment that you or your partner have:

Name and address of the employer
Payroll, employee or staff number
Employment start and end date
Hours worked per week
How often wages are paid and the typical amount paid
Details of any statutory, maternity, paternity or adoption pay and expected return date

Please tell us about any other employment(Required)

State Benefits

We need to know about benefits you (or your partner if you have one) receive or have received from the Department for Work and Pensions, The Pension Service, HM Revenue and Customs, Veterans UK or any other government department paying benefits. This includes any State Retirement Pension.

Do you or your partner currently receive any state benefits?(Required)

Yes

Tell us about the benefits received(Required)

Please list all the benefits received by you and your partner. Enter the information about the benefits and then click on the + sign to add another row for each type you have.

Received by (claimant or partner)

Type of income

Amount received £

How often (weekly, fortnightly, four weekly or monthly)

Have you or your partner claimed any state benefits?(Required)

Yes

Tell us about the benefits you have applied for and are awaiting a decision on(Required)

Please list all the benefits you and your partner have applied for and are awaiting a decision on. Enter the information about the benefits and then click on the + sign to add another row for each type you have.

Claimed by (claimant or partner)

Benefit claimed

Other income

We need to know about any other incomes you (or your partner if you have one) receive, for example private pensions and annuities.

Do you or your partner receive any other income?(Required)

Yes

Tell us about any other income received(Required)

Please list any other income received by you and your partner. Enter the information about the income then click on the + sign to add another row for each type you have.

Received by (claimant or partner)

Received from

Type of income

Amount received £

How often (weekly, fortnightly, four weekly or monthly)

If you (or your partner) are pensioners do you or your partner have any funds in a pension scheme that you do not currently receive any income for?(Required)

Yes

Not pension age

Tell us about any unclaimed pensions(Required)

If you are pension age we will need evidence showing the amount of income you could currently receive for each if it were converted to a pension or annuity.

Please list any unclaimed pensions held by you and your partner. Enter the information about the pensions and then click on the + sign to add another row for each type you have.

Pension fund for (claimant or partner)

Pension provider

Captial – About any bank and building society accounts, savings and investments

Capital includes bank, building society or Post Office accounts, savings or investments (this includes ISAs linked to mortgages), Premium Bonds or stocks and shares, property in the UK or abroad including any money, property or land that is being looked after for you or any money owed to you.

Capital does not include personal possessions such as cars and jewellery and we do not take into account the value of the property you normally live.

Working age – If your capital is more than £6,000 you will not be entitled Council Tax Support.

Pension age – If your capital is from £10,000 to £15,999, we will take a tariff income from this capital when calculating how much Council Tax Support we can pay.

If your capital is above £16,000 you will not be entitled to Council Tax Support.

Do you (or your partner if you have one) own or partly own any land or property registered in your name other than the house you live in here or abroad?(Required)

Yes

Is your total household capital above £5,500?(Required)

Yes

Tell us about any property or land(Required)

For each property owned we will need you to complete a LA1 form to provide additional information about the property.

Please list the address of any land or property you or your partner own or partly own. Enter the information and then click on the + sign to add another row for each type you have.

Address of the property or land

Tell us about any bank, building society or post office accounts you or your partner have. (If you do not have any write none in the name of bank or building society box)(Required)

Please list all the accounts. Enter the information and then click on the + sign to add another row for each type you have.

Name of the bank or building society

Account number (last three numbers)

Amount £

Held by (claimant or partner)

Do you or your partner have any stocks, shares, bonds or trusts here or abroad?(Required)

Yes

Tell us about your stocks, shares, bonds or trusts you or your partner have(Required)

Please list all stocks, shares, bonds or trusts held by you and your partner. Enter the information and then click on the + sign to add another row for each type you have.

Name of the company

Number of shares

Held by (claimant or partner)

Do you or your partner have any National Savings Certificates or Premium Bonds?(Required)

Yes

Tell us about each National Savings Certificate or Premium Bond you or your partner have(Required)

Please list all National Savings Certificates and Premium Bonds held by you and your partner. Enter the information and then click on the + sign to add another row for each type you have.

Name

Issue type

Amount invested £

Date of issue

Held by (claimant or partner)

Award start date

Your award can be backdated up to 3 months if your circumstances qualify you for Council Tax Support.

If you were not entitled to Universal Credit or Pension Credit for this earlier period, we may need to ask for further evidence to allow us to assess any entitlement.

Council Tax Support will normally begin from the Monday following the date you want to claim from if it is within the last three months.

If you leave this date blank we will either treat your claim as being from the date this form was submitted, or we will consider awarding up to three months backdating if you were entitled to Universal Credit or Pension Credit during that period.

What date would you like your award to be considered from?

Day

Month

Year

About the proof you need to provide

Below is a list showing what evidence will be needed to support your claim, this is a general list to provide guidance on what we will need.

If you don’t have the evidence don’t worry, just submit the form without it and we will let you know if we need any further evidence in support of your claim.

Proof you (and your partner if you have one) need to upload

As you or your partner are self-employed, please also complete a Housing benefit and council tax support self-employed income form.

Proof of identity

Evidence can include: birth certificate, marriage certificate, passport, medical card, driving licence, UK residence permit, EU National Identity card, recent gas or electricity bill.

Proof of National Insurance Number

Evidence can include: National Insurance card, Department for Work and Pensions (DWP) letter, wage slip, P45/P60, pension letter, Tax Credit award letter.

Other income

If you receive any other income you will need to provide evidence showing how much is normally received and how often. For pensions or annuities you should normally provide a pension slip showing the payment details including the gross payable and any deductions being made.

Capital

Income of other adults in your household

If you, or your partner, receive Attendance Allowance, Personal Independence Payment Daily Living component or Disability Living Allowance care component we will not need evidence of any non-dependants income as no deduction will be made for them.

If the other adults in your household normally work for 16 hours or more you will need to provide evidence of their earnings and other income so the correct non-dependant deduction can be taken. For earnings provide their last two monthly, or four weekly pay slips, or last five weekly pay slips.

Will you upload your proof now or within one calendar month?(Required)

I will upload my proof to this form now

I can’t upload my proof to this form now, I’ll send it within one calendar month

Please upload proof of any documents we need to see:(Required)

If you are uploading photographs of documents, please make sure you take a photo of every relevant page, that they are clear and that any words or figures can be easily read. Max 10 uploads, each document should be no bigger than 2MB

Drop files here or

Max. file size: 20 MB, Max. files: 10.

About any other information

If there is any information you want to tell us about that hasn’t been covered previously, or additional information you want to provide to support your claim tell us below.

Other information

If you have no further information to give, leave this box blank