Tell us about a change in circumstances 1Using the form2Declaration3About you (the claimant)4About the change Change in circumstances (not a change of address) You need to tell us straight away about any change that could affect your Council Tax Support or Housing Benefit, please continue to complete this form. Change of address It is important to report a change in address as soon as possible to make sure that your Housing Benefit and/or Council Tax Support award remains correct and to make sure any correspondence is sent to the correct address. If you have moved and are currently in receipt of Housing Benefit and/or Council Tax Support please complete a Tell us about your move form. Not in receipt of Housing Benefit If you have moved and are not currently in receipt of Council Tax Support or Housing Benefit, please complete a Council Tax moving home form. Below are some of the common changes you need to tell us about (this is not a full list). If you’re not sure, tell us about a change anyway and we will let you know if it affects your Housing Benefit or Council Tax Support. Income, savings and investments (capital) changes in wages, maintenance payments, works pensions and so on if any sort of income starts, stops or the amount you get goes up or down if you start or stop work or your hours of work change if you or your partner is of working age, you need to tell us if your combined capital increases to over £5,500 if you or your partner is of qualifying age for Pension Credit, you need to tell us if your combined capital increases to over £9,500. Benefits if you start or stop getting Income Support, Jobseeker’s Allowance, Employment and Support Allowance or Universal Credit if any other benefit starts or stops or the amount changes if a tax credit like Working Tax Credit or Child Tax Credit starts or stops, or if the amount changes. People who live with you if anyone comes to stay with you or moves out, including people who go into hospital or prison if you become a couple if anyone who lives with you starts or stops work if there is any change in the income of someone who lives with you if you have a new baby if a child or young person leaves school if you stop receiving Child Benefit for a child. If you are receiving Housing Benefit – Private rents and housing association rents if your landlord puts your rent up or down if the services included in your rent change if the part of the property you live in changes. For example, you may move to a different room in the same property or take on extra rooms. If your landlord changes. (Council tenants do not need to tell us about changes to their rent) If you move or are away from home if you move home, even to another room in the same building if you will be away from home for more than four weeks (including going into hospital). Other changes changes to the amount of childcare you pay If you become a student or finish your course changes to your email address. If you change your name. If you’re not sure, tell us about a change anyway and we will let you know if it affects your Housing Benefit or Council Tax Support. This form will ask you to provide your details including date of birth and National Insurance number details of the change and the date it occurred proof of the change, if applicable Please have this information ready as pages time-out after one hour. Do not use your browser back button – if you need to go to a previous page click on the previous button at the bottom of each page. Privacy Statement Dover District Council is a Data Controller under GDPR. In submitting this form we will collect and process your personal data. For information about your rights and how the Council uses your data, please view our Corporate and relevant service privacy notice which can be found on our Privacy Page. DeclarationAre you filling in this form for you or on behalf of someone else?(Required) I am filling in this form for me I am filling in this form on behalf of someone else Please check the box below to confirm that you have read, understand and agree to the following statements before completing this form: I confirm the details I will give are correct and true. I understand that if I give information that is false this could lead to a penalty or legal proceedings being taken against me. I agree that you will use the information I have provided to process my claim for Housing Benefit or Council Tax Support, or both. You may check some of the information with other sources as allowed by the law. I understand that you may use any information I have provided in connection with this and any other claim for social security benefits that I have made or may make. You may give some information to other organisations, such as government departments, local authorities and private-sector companies such as banks and organisations that may lend me money, where the law allows this. I know that I must tell you straight away in writing about any change in my circumstances which might affect my claim. This field is hidden when viewing the form Please check the box below to confirm that you have read, understand and agree to the following statements before completing this form: As far as possible, I will confirm with the person claiming that the answers I will give on this form are correct and that the documents I will upload as proof are original copies and have not been edited in any way. I understand that if I give information that is false this could lead to a penalty or legal proceedings being taken against me. I understand my data may be shared with other departments as permitted by law. This field is hidden when viewing the formDeclaration(Required) I understand and accept the above declarationWe will not be able to discuss the claim with the person who is completing the form on the claimant’s behalf unless they provide written permission to do so, unless you are already an appointee, have lasting power of attorney or are a court appointed deputy.I am filling in this form on behalf of(Required)As they cannot fill in the form because(Required)Is the claimant aware that you are completing this form on their behalf? Yes No Full name of the person completing this form(Required)Relationship to the person claiming(Required)Contact email address or phone number(Required)We might need to contact you to check the information you’ve given us About you (the claimant)What support or benefit are you receiving?(Required)Please select all that apply Council Tax Support Housing Benefit Benefit reference numberCouncil Tax account numberTitle (for example Mr, Mrs, Ms, Miss)(Required)First name(Required)Last name(Required)Contact phone number(Required)Please provide a mobile number if you have one as we are now using text messaging (SMS) to contact some of our residents.Email address(Required)We will use your email address to send the receipt of your form, including the form reference number. This may include personal data. We will also use your email address to contact you about your Council Tax account and/or benefits. Enter email address Confirm email address Date of birth(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920National Insurance number(Required)About your addressAddress(Required)If you are renting a room include the room number Address line 1 Address line 2 Town or city Postcode About the change in your circumstancesIf you have more than one, please tell us about each one separately and provide the date each change occurred. If you have evidence of the change in your circumstances you can upload copies of it with this form. Please let us know if your email or phone number has changed. About the first changeDate the change occurred? (1)(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What has changed? (1)(Required)Upload proof of this change (1) Drop files here or Select files Max. file size: 6 MB, Max. files: 3. Do you have another change to tell us about?(Required) Yes No About the second changeDate the change occurred? (2)(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What has changed? (2)(Required)Upload proof of this change (2) Drop files here or Select files Max. file size: 6 MB, Max. files: 3. Do you have another change to tell us about? (2)(Required) Yes No About the third changeDate the change occurred? (3)(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What has changed? (3)(Required)Upload proof of this change (3) Drop files here or Select files Max. file size: 6 MB, Max. files: 3. Do you have another change to tell us about? (3)(Required) Yes No About the fourth changeDate the change occurred? (4)(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What has changed? (4)(Required)Upload proof of this change (4) Drop files here or Select files Max. file size: 6 MB, Max. files: 3. Do you have any other changes to tell us about? (4)(Required) Yes No About any other changesPlease tell us about any other changes(Required)Enter the information and then click on the + sign to add another row for each additional change you have.Date the change occurred? (dd/mm/yyyy)What has changed? Add RemoveUpload proof of these changes (other) Drop files here or Select files Max. file size: 6 MB, Max. files: 3.
