Apply for the Council Tax Support exceptional hardship award 1Using the form2Declaration3About you4Reasons for applying5Your accounts6Your income7Your income (continued)8Your outgoings9Your loans and debts10Other information and proof Complete this form to apply for an exceptional hardship award. If you have not yet discussed a Council Tax payment plan with us, then don’t fill this form in yet. Phone our Council Tax Team first on 01304 872199. This form will ask you to provide your details including National Insurance number details about why you need help, future changes and what you are doing to help your situation details of all your bank, building society and Post Office accounts, including the account numbers and how much is in each the amount of Council Tax you pay per month for the current financial year the amount of rent or mortgage you pay and Housing Benefit you get per week a full list of every type and amount of money coming into your household (your household income) and how often you get this a full list of every type and amount of money going out of your household (your household outgoings) and how often you pay this a full list of every type of loan and debt you pay per week and the total amount of each outstanding proof of all your bank, building society and Post Office accounts, and of all your income and outgoings if you are self-employed, a copy of your accounts for the past year or a completed self-employed income form. You can upload your proof to this form now or you can send it later, but your application won’t be decided until we have received proof. If you don’t provide proof within two weeks of completing this form your application will be cancelled and you will need to apply again if you wish to do so. Please have this information ready as pages time-out after one hour. Please do not use your browser’s 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. DeclarationPlease 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 that the documents I will upload as proof are original copies and have not been edited in any way. I confirm that I will notify you of any relevant changes straight away. 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. Declaration(Required) I understand and accept the above declaration About youTitle (for example Mr, Mrs, Ms, Miss)(Required)First name(Required)Last name(s)(Required)Contact phone number(Required)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 benefit claim and Council Tax account. Enter email address Confirm email address Would you like to receive your Housing Benefit, Council Tax Support notifications and Council Tax bills by email?(Required)You can receive your Housing Benefit, Council Tax Support notifications and Council Tax bills by email rather than post. We will send all future Housing Benefit and Council Tax Support notification letters and Council Tax bills to the email address you have given above. 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 No Housing Benefit or Council Tax Support reference number(Required)National Insurance number(Required)About your addressAddress Address line 1 Address line 2 Town or city Postcode Reasons for applyingWhy do you need extra help to pay your council tax?(Required)What are you doing to improve your financial situation?(Required)Is anything likely to change in the near future that will allow you to meet the shortfall in your council tax? Your bank, building society and Post Office accountsPlease fill in the table below listing all bank, building society and Post Office accounts held by you and your partner (if you have one) and list the amounts in each account. If you have no bank accounts, please leave blank.Bank, building society and Post Office accounts held by you and your partnerClick on the + sign to add a new row.Name of bank or building societyAccount numberAmount Add Remove About your incomePlease list all the money coming into the household and select how often. This includes any income you and your partner receive and if any other adults living in the property contribute any money towards the household. If you get any income not listed, please give amounts using the ‘other income’ option.Income typePlease select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount receivedHow oftenPlease select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount received(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount received(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount received(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount received(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount received(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount received(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount received(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount received(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount received(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount received(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount received(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount received(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount received(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount received(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount received(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount received(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthIf you have included 'other income' as an option above, please give details about this other income About your income (continued)Are you self-employed?(Required) Yes No We will need to see copies of your accounts for the past year. If you don’t have these you will need to complete a self-employed income form (you can find this form on our website). About your outgoingsPlease list all of your household outgoings and select how often. If you have any outgoings not listed, please give amounts using the ‘other expense’ option.Priority outgoingsType of outgoingPlease select…Broadband / home phoneChild maintenanceCouncil TaxElectricityGasRentTV licenceWater ratesAmount paidHow often?Please select…Every weekEvery monthAdd another priority outgoing?(Required) Yes No Type of outgoing(Required)Please select…Broadband / home phoneChild maintenanceCouncil TaxElectricityGasRentTV licenceWater ratesAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another priority outgoing?(Required) Yes No Type of outgoing(Required)Please select…Broadband / home phoneChild maintenanceCouncil TaxElectricityGasRentTV licenceWater ratesAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another priority outgoing?(Required) Yes No Type of outgoing(Required)Please select…Broadband / home phoneChild maintenanceCouncil TaxElectricityGasRentTV licenceWater ratesAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another priority outgoing?(Required) Yes No Type of outgoing(Required)Please select…Broadband / home phoneChild maintenanceCouncil TaxElectricityGasRentTV licenceWater ratesAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another priority outgoing?(Required) Yes No Type of outgoing(Required)Please select…Broadband / home phoneChild maintenanceCouncil TaxElectricityGasRentTV licenceWater ratesAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another priority outgoing?(Required) Yes No Type of outgoing(Required)Please select…Broadband / home phoneChild maintenanceCouncil TaxElectricityGasRentTV licenceWater ratesAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another priority outgoing?(Required) Yes No Type of outgoing(Required)Please select…Broadband / home phoneChild maintenanceCouncil TaxElectricityGasRentTV licenceWater ratesAmount paid(Required)How often?(Required)Please select…Every weekEvery monthNormal household expensesType of outgoingPlease select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount paidHow often?Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount paid(Required)How often?(Required)Please select…Every weekEvery monthNon-essential costsType of outgoingPlease select…Cable or Sky TVCigarettes or vape / alcoholEating outGamblingLeisure activitiesLotteryOther expenseAmount paidHow often?Please select…Every weekEvery monthAdd another non-essential cost?(Required) Yes No Type of outgoing(Required)Please select…Cable or Sky TVCigarettes or vape / alcoholEating outGamblingLeisure activitiesLotteryOther expenseAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another non-essential cost?(Required) Yes No Type of outgoing(Required)Please select…Cable or Sky TVCigarettes or vape / alcoholEating outGamblingLeisure activitiesLotteryOther expenseAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another non-essential cost?(Required) Yes No Type of outgoing(Required)Please select…Cable or Sky TVCigarettes or vape / alcoholEating outGamblingLeisure activitiesLotteryOther expenseAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another non-essential cost?(Required) Yes No Type of outgoing(Required)Please select…Cable or Sky TVCigarettes or vape / alcoholEating outGamblingLeisure activitiesLotteryOther expenseAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another non-essential cost?(Required) Yes No Type of outgoing(Required)Please select…Cable or Sky TVCigarettes or vape / alcoholEating outGamblingLeisure activitiesLotteryOther expenseAmount paid(Required)How often?(Required)Please select…Every weekEvery monthAdd another non-essential cost?(Required) Yes No Type of outgoing(Required)Please select…Cable or Sky TVCigarettes or vape / alcoholEating outGamblingLeisure activitiesLotteryOther expenseAmount paid(Required)How often?(Required)Please select…Every weekEvery monthIf you have included 'insurance – other' as an option above or have any other outgoings, please give details about theseDo you have any outstanding loans or debts (including rent arrears)?(Required) Yes No About your loans and debtsPlease list all of your loans and debts including the amount payable per week and the total amount you owe.Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)What steps have you taken to reduce the amounts owed?(Required)Please upload proof of these debtsYou can upload up to five documents. Each document should be no bigger than 2MB. If you have more documents to upload, you can do so later in the form Drop files here or Select files Accepted file types: txt, pdf, doc, docx, rtf, jpg, jpeg, tif, tiff, bmp, png, xls, xlsx, Max. file size: 15 MB, Max. files: 5. Proof for your application and other informationYou need to provide proof of your bank, building society or Post Office accounts and of all your income and outgoings. You can upload these to this form now or you can send them later but we won’t process your application until we have received your proof.Will you upload your proof now or within the next two weeks?(Required)You must send your proof within the next two weeks otherwise we will cancel your application and you will need to reapply, if you wish to do so. I will upload my proof to this form now I can’t upload my proof to this form now, I’ll send it within the next two weeks Upload proof for your applicationUpload up to five documents(Required)You can upload up to five documents. Each document should be no bigger than 2MB. We’ll give you a link at the end of this form to upload more documents, if you need to. Drop files here or Select files Accepted file types: txt, pdf, doc, docx, rtf, jpg, jpeg, tif, tiff, bmp, png, xls, xlsx, Max. file size: 15 MB, Max. files: 5. Other informationPlease use this box to tell us any other informationIf you have no further information to give us, leave the box blank
