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Your Housing Benefit / Council Tax Reduction entitlement is being reviewed. Please complete all the sections below, even if your circumstances have not changed since you last completed a Housing Benefit Review form.
Other people who live with you list the names of everybody else who lives in your household, including dependent children and any other adults. If no one else lives with you, please write “none”.
Give details of all Income you receive (for all members of your household) and how often you receive them (e.g. weekly, four weekly, monthly etc.) Examples would include Universal Credit, Child Benefit, Working Tax Credit, Child Tax Credit, PIP, Carers Allowance, Job
Seekers Allowance, Private/State Pension, Maintenance payments and Earnings etc.
If you are self employed, please visit Change a Claim to complete a Change of Circumstances form.
If your (and your partner’s joint) capital is less than £6,000 please write “capital below threshold” if your capital is over £6,000 please give details of all your bank accounts (including current accounts), building society accounts, Post Office accounts,
investments, stocks, premium bonds, shares, National Savings Certificates, property or land you own etc.
Only complete this section if you live in rented accommodation.(If you do not live in rented accommodation go on to the next section).
Does your rent include anything other than rent for the property, such as water or heating charges for example? If yes, tell us how much you pay and what it is for.
Use this box to tell us anything else that has changed, or has not been covered in the previous sections. If you incur child care costs, please give details. If there are no other changes write “none”.
We will process personal information included in this form to enable us to assess your benefit entitlement. The Council processes this information legally in its performance of public task. Your information may be shared with other parties in connection
with your claim. Please see for more information.
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