Apply for a housing payment 1Using the form2Completing the form3Declaration4Declaration5The claimant6The landlord7Reasons for applying8The property9Reasons continued10Income11Outgoings12Loans and debts13Proof14Universal credit15Payment Use this form to apply for housing payments if you are getting Housing Benefit or the housing costs element of Universal Credit and need more help with your housing costs. If you aren’t getting one of these benefits, your application may be refused If you need advice on your housing situation, you need to speak to our Housing Team. Please read the information about housing payments including who can apply before completing this form. This form will ask you to provide your details including National Insurance number why you need help, future changes and what you are doing to help your situation the amount of rent 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 these 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 getting or have applied for Universal Credit, we will need a full list of people who live with you, including full name, date of birth and relationship to you if you are facing eviction, you will need to provide evidence such as rent arrears statements, section notices or possession orders evidence from your support worker (if you have one). 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. Proof to support your application 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. 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. The person completing this formAre you filling in this form for yourself or on behalf of someone else?(Required) I am filling in this form for myself I am filling in this form on behalf of someone else Declaration – filled in this form on behalf of someone elsePlease 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. Declaration(Required) I understand and accept the above declaration I am filling in this form on behalf of(Required)As they cannot fill in the form because(Required)Full name of the person completing this form(Required)Relationship to the person claiming(Required)Contact email address or phone number(Required)If we need to check any of the details given, we may need to contact you 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 on this form will be correct and true. 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. I understand that housing payments can only be made if I am currently getting either Housing Benefit or the housing costs element of Universal Credit, and that I must provide proof of this. I understand that if I’m not getting either of these benefits then my application may be refused. Declaration(Required) I understand and accept the above declaration About you – claimantTitle (for example Mr, Mrs, Ms, Miss)(Required)First name(Required)Last name(s)(Required)Contact phone number(Required)We ask for your phone number so we can call you or send you important text messages (if we need to) about your claimEmail 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 (if known)National Insurance number(Required)Date of birth(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920About your addressAddress(Required) Address line 1 Address line 2 Town or city Postcode If you are applying for a housing payment to help with rent in advance or rent deposit, you will be asked for the address of the new property later. About your landlordName of landlord(Required)Landlord's address (including postcode)(Required)Landlord's phone numberLandlord's email address Reasons for applyingPlease select what are you applying for a housing payment for help with(Required) Rent in advance Rent deposit Help with paying rent About the rent depositHow much is the rent deposit?(Required)How is the deposit going to be protected?(Required)By law your deposit must be secured in a deposit protection scheme. Please ask your new landlord or agent which scheme they are going to use.About the rent in advanceHow much is the rent in advance?(Required)Please enter numbers only, no pound (£) sign About the property you want to move toAddress you want to move to including postcode(Required)Date you want to move in(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date you viewed the property(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920How much will the rent be?(Required)Please enter numbers only, no pound (£) signHow often will this rent need to be paid?(Required)Please select…WeeklyTwo-weeklyFour-weeklyMonthlyWhy do you need to move from your current property?(Required)If your application is being supported by the Housing Options department or another agency, for example Social Services, Porchlight or the Probation Service, please give detailsFor example the name of the agency and officer supporting your application. Reasons for applying – continuedWhy do you need housing payments?(Required)What are you doing to improve your financial situation?(Required)A housing payment is a short-term award. Is anything likely to change in the near future that will allow you to meet the shortfall in your rent?Were you aware of the amount of Housing Benefit that could be paid before you moved in?(Required) Yes No What steps have you taken to find other suitable housing or reduce your rent?How is the property suitable for you and your family?(Required)For example, has it been adapted if you have a disability, or has ground floor accommodation?Have you or a family member any health problems, disabilities or special dietary needs?(Required)If you have any additional expenses due to health reasons, please tell us here. Please upload any supporting evidence later in this form, for example medical certificates. 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 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 paid(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 paid(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 paid(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 paid(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 paid(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 paid(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 paid(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 paid(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 paid(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 paid(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 paid(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 paid(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 paid(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 paid(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 paid(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 paid(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 paid(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 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 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 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 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 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? 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?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 applicationYou 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. Universal CreditAre you getting or have you applied for Universal Credit?(Required) Yes No Additional information for Universal Credit claimantsPlease tell us all the people who live with youClick on the + sign at the end of the row to add a new personFirst nameLast nameDate of birth (dd/mm/yy)Sex of childRelationship to you Add RemovePerson 1Please tell us all the people who live with youFirst nameLast nameDate of birth Sex of childRelationship to youAdd a second person? Yes No Person 2First nameLast nameDate of birth Sex of childRelationship to youAdd a third person? Yes No Person 3First nameLast nameDate of birth Sex of childRelationship to youAdd a forth person? Yes No Person 4First nameLast nameDate of birth Sex of childRelationship to youAdd a fifth person? Yes No Person 5First nameLast nameDate of birth Sex of childRelationship to youAdd a sixth person? Yes No Person 6First nameLast nameDate of birth Sex of childRelationship to youAdditional information about your propertyPlease tell us the following information about your propertyNumber of bedrooms(Required)Number of living rooms(Required)Weekly or monthly rent due (please state if weekly or monthly)(Required)Tenancy start date(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name of your landlord or agent(Required) Paying your housing payment awardName of bank or building society(Required)Branch address(Required)Name(s) as they appear on your bank or building society account(Required)Account number(Required)This will be the 8 digit account number shown on your bank statementSort code(Required)Please enter numbers only, for example 112233
