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Name and address

Claim reference

Proof

The City of Cardiff CouncilNotes for fi lling in the Housing Benefi t / Council Tax Reduction / Free School Meals claim form

Filling in the form

About this form

This claim form has been specially designed to be easy to fi ll in. It may seem rather long, but we have to ask a lot of questions to make sure that everyone who claims gets the right entitlement.

You may not have to fi ll in all parts of the form, but you must fi ll in any part that is relevant to you. Every part starts with a question to help you decide if you need to fi ll in that part.

Use black ink to fi ll in the form.Do not use pencil. If you make a mistake, just cross it out and put the right answer next to it. Do not use correction fl uid or tape.

Answer ‘Yes’ or ‘No’ questions by putting a tick in the relevant box. If you are picking an answer from a list of answers, put a tick in the relevant box.

If someone else fi lls in the form for you, there is a special space for them to sign in Part 18.

If you need help fi lling in the form

If you need any help, our Hub addresses and phone numbers are shown on the ’Contact information’ page.

If English is not your fi rst language and you need help fi lling in the form, we may be able to help you. Please contact:

Central Library HubSecond FloorCentral LibraryThe HayesCardiffCF10 1FL

If you are sending documents by post please use the address at the top of the next page.

We need to see proof of some of the things you tell us about. There is a checklist in Part 17 to help you. If you are not sure if we need to see proof of something, get in touch with us. We will tell you what we need to see. We cannot pay you until we have seen the proof we have asked for.

The Council welcomes correspondence in English and Welsh, and this form is also available in Welsh.

Mae’r Cyngor yn croesawu gohebiaeth yn Gymraeg a Saesneg, ac mae’r ffurfl en hon ar gael yn Gymraeg.

What to do next

When you have fi lled in the form, sign it and send it to us with the proof we need to:FREEPOST CARDIFF COUNCIL HOUSING BENEFITPO Box 6000Cardiff CF11 0WZ Or you can bring in the form and the proof to us at one of the Hubs shown on the ‘Contact information’ page.If you cannot get the proof we need straight away, do not worry. Send the form to us, but let us know that you will be sending some proof later. If you do not send the form to us straight away, you might lose money. If you cannot get the proof within 2 or 3 weeks, let us know. We may be able to help you.

When we usually pay benefi t fromWe will usually pay you Housing Benefi t from the Monday after we get your form. Council Tax Reduction will usually start from the day we get your form.

You may be prosecuted if you deliberately fail to declare changes in your circumstances.

Please keep the form on page 31 and use it to tell us about changes in your circumstances.

How we collect and use information We will use the information you give us in this form, and in any proof you send us, to process your claim.

We may pass this information to other agencies or organisations such as the Department for Work and Pensions and HMRC as allowed by law.

By law, we may check the information you have provided, or information provided about you by someone else, against other information we already have. We may also ask other agencies, organisations, local authorities or government departments to give us information they have about you to:•Make sure the information is accurate•Prevent or detect crime; and•Protect public funds.

We will not give information about you to anyone else, or use information about you for other purposes, unless the law allows us to.

The City of Cardiff Council is the data controller for the purpose of the Data Protection Act 1998. If you want to know more about what information we have about you, or the way we use that information, you can ask.

Local Housing Allowance (LHA) for Private Tenants only

Housing Benefi t will be based on set LHA rates, these rates are the maximum amount you can claim and will be the same throughout Cardiff.

The rate you will qualify for will depend on the size and age of your household and whether or not you live in shared accommodation.

The rates will be published in advance, so you know the maximum rent Housing Benefi t could pay before you rent a property.

Normally LHA will be paid to you and you will not be able to choose to have payments made to your landlord. But if there is a reason why you cannot manage your own rent payments you should tell us why.

The safest method of payment is straight into your bank account and if you want details about setting up a bank account an explanatory leafl et is available.

For more information on LHA, the standard allowances or setting up a bank account:

•Call in to your local Hub •Email benefi [email protected]•Log on at www.cardiff.gov.uk/benefi ts•Telephone Connect 2 Cardiff on 029 2087 2087

Changes you must tell The Benefi ts Section aboutYou must tell the Council’s Benefi ts Section about any changes in your circumstances that could change the amount you receive.The changes you should tell us about include, but are not limited to:•If you change address•If you or your partner start work, change job or have a pay increase•If there is a change to any income that you or your partner receive•If any welfare benefi ts change such as Tax Credits•If Jobseeker’s Allowance or Income Support stops•If one of your children changes or leaves school•If you or your partner have a baby•If anyone moves in or out of the property, even on a temporary basis•If you have a new partner or become married or separated•If your savings change, but only if they are above £6,000 in total•If you start or stop paying childcare costs or if the amount changes•If your rent changes (unless you are a Council tenant)•If anyone in your home has a change of circumstances such as the ones listed above

If you are required to register your employment with the Home Offi ce remember to tell them if you change your job and tell us too.

Please note these are just examples and you should tell us about any change that might affect your benefi t straightaway. If you are not sure, please contact us for advice.

You must tell the Council’s Benefi ts Section about the changes. Do not rely on someone else to pass the message on and do not just tell the Job Centre or the Pension Service.

If It’s New Tell Us Too!OverpaymentIf you delay in telling us about a change of circumstances you may have to pay money back. Action may be taken if you do not do so.

The City of Cardiff CouncilA claim form for Housing Benefi t / Council Tax Reduction / Free School Meals

Part 1 About you and your partner

Are you (please tick one box):

a council tenant?a private tenant?

Do you have a partner who normally lives with you?By Partner we mean• a person you are married to or a

person you live with as if you aremarried to them, or

• a civil partner or a person you live with as if you are civil partners

Last name

Other names

Date of Birth

Title(Mr, Mrs, Ms and so on)

AddressThis is the address that you want to claim benefi t for.Do not tell us your partner’s address if it is the same as yours.

National Insurance NumberYou can fi nd this on payslips or letters from social security or the tax offi ce. We cannot decide your claim if we do not have your National Insurance Number.

Tell us any other names you have used.Your phone number/emailYou do not have to tell us this, but it may help us deal with your claim more quickly.

What date did you move to this address?If you have moved home in the last 12 months, tell us your last address and the date you left the property.

Have you or your partner come to live in England, Northern Ireland, Scotland, Wales, the Republic of Ireland, the Channel Islands or the Isle of Man in the last 5 years?

an owner-occupier?a housing association or social landlord tenant? a hostel resident?

Did you claim at your last address? No Yes

No

Yes

For offi cial use

Date issued

Receipt Stamp

Postcode:

Postcode:

Tel:

E-mail: E-mail:

Tel:

We will write to you about this. We will write to you about this.

Letters LettersLetter LetterNumbers Numbers

Postcode:

Postcode:

You Your partner

No

Yes

No

Yes

/ /

/ /

/ /

/ /

/ /

/ /

If you have a partner,you must answer all the questions about them.

1

Part 1 About you and your partner - continuedIf your nationality is not British, on what date did you last arrive in the UK?What is your nationality?The UK is England, Northern Ireland, Scotland and Wales.

Have you or your partner claimed Housing Benefi t/ Council Tax Reduction within the last 5 years?

Are you or your partner in hospital at the moment?

Please tick if you or your partner are:• a veteran of the armed forces

• a student

• a former resident of a homeless hostel

• an apprentice

• on youth training

• in legal custody

• severely mentally impaired

• registered blind

• long term sick or disabled and incapable of work

Does anyone get Carer’s Allowance for looking after you or your partner?Please tick ‘Yes’ if they have been told they are entitled to Carer’s Allowance even though they do not get it, because they are getting another benefi t instead.

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

You

Nationality

Your partner

Nationality

When did you claim?

When did you go in?

Please give their name and address. Please give their name and address.

When did you go in?

What address did you claim for?

When do you expect to come out? When do you expect to come out?

What address did you claim for?

When did you claim?

Postcode:

Postcode:

Postcode:

Postcode:

We will contact you if we need any more information.

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

2

Part 2 About childrenWe need to know about any children in your household who are:

• under 16;• aged 16 or 17 and registered for work or youth training; or• aged 16 or over, but still under 20 and in education doing a course not higher than GCE A level, SCE Higher level or GNVQ (advanced).

Are there any children in your household as described? Tell us about the children you want to claim for. If you want to

claim for more than 3 children, use a separate sheet of paper.

Do you want to claim Free School Meals for this child?

What school does the child attend?

Who gets the Child Benefi t for them?We need to see proof of this.

Do you pay any childminding costs for this child?For example, to a childminder, nursery or after-school club.

Is the child registered blind or getting Disability Living Allowance?

Please tick ‘Declined’ if you think you may be entitled to Free School Meals but do not wish to receive them.

No

Yes

No

Yes

No

Yes

No

Yes

Declined Declined Declined

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

First child Second child Third child

Go to Part 3.

If you are sending a separate sheet of paper, tick this box.

Last name

Other names

Date of birth

What is the child’s sex?

The child’s relationship to you

/ /

£ £ £

/ / / /

Tell us the name andregistration numberof the child minder

How much do you pay a week?

We need to see proof.

Read the Checklist at Part 17 to see what you can use as proof.

We need to see proof. We need to see proof.

How much do you pay a week? How much do you pay a week?



3

Part 3 About other people who live with youDo any adults normally live with you and your partner?By adults we mean people over 16 who nobody gets Child Benefi t for.

No

Yes

No

Yes

Are any of the people who normally live with you married to each other or living together as if they were married?

Tell us about all the adults, except your partner and any joint tenants, who usually live with you. If you want to tell us about more than 3 people, use a separate piece of paper.

Go to Part 4.

Last name

Other names

Date of birth

Now tell us about all the people who normally live with you and your partner.


No

Yes

No

Yes

Tell us their names. is the partner of

is the partner ofAnd

First person Second person Third person

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

National Insurance NumberWe can make a decision on your claim quicker, if you give us this information.

Do they get Universal Credit?

Do they get Income Support, Jobseeker’s Allowance (income-based), Pension Credit or Employment and Support Allowance (Income-Related)?

Do they get Disability Living Allowance, Attendance Allowance, Personal Independence Payment or are they registered blind?

Are they a full-time student, a student nurse, a care worker, an apprentice or on youth training?

Do they pay rent to you or your partner?

Letters Numbers Letter Letters Numbers Letter Letters Numbers Letter

/ / / / / /

4

Their relationship to youFor example, brother, daughter, father, grandson, grandmother, aunt, stepdaughter or friend.

Part 3 About other people who live with you - continued

Are they severely mentally impaired?

Are they in legal custody at the moment?

Are they in hospital at the moment?

Do they normally work for 16 hours or more a week?

Do they have any other income at all?

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

YesTell us their other income before deductions for things like tax and National Insurance.

Tell us their other income before deductions for things like tax and National Insurance.

Tell us their other income before deductions for things like tax and National Insurance.

Tell us their earnings before deductions for things like tax and National Insurance.

When are theyexpected to comeout?



When did they go in?



When are they expected to come out?





£ £ £

We need to see proof of their earnings.



We need to see proof of their income.

£ £ £



Read the Checklist at Part 17 to see what you can use as proof.

/ / / / / /

/ / / / / /

/ / / / / /

5

Part 4 About rent

Do you own your own home or have a mortgage?

Are you a Council tenant?

When did you start renting your home?

When did you move to this address?If you have not moved in yet, tell us when you expect to move in.

What sort of tenancy do you have?For example, shorthold, tied rent or something like this.

How long is the tenancy for?

Please tick to show if the property is let as: Furnished Partly furnished

Minimally furnished

Unfurnished

How much rent are you charged?

Does anyone else share the rent with you and your partner?

Has your rent changed in the last 12 months?

When is the next rent increase due?

Has your rent been registered as a fair rent by the rent offi cer?

No

Yes

No

Yes

Answer the next question.

Answer the questions below.

Go to Part 5.

Go to Part 6.

to

£ every

No Yes

(week/2 weeks/ 4 weeks/ month)

No

YesSend us proof of the date it changed, and by how much it changed.

Please send us the notice of registration form R05.

No

Yes

/ /

/ /

/ / / /

/ /

6

Last name

Other names

Date of birth

First person Second person Third person

/ / / / / /Their relationship to youFor example, brother, daughter, father, grandson, grandmother, aunt, stepdaughter or friend.

No Yes

Part 4 About rent - continued

No

Yes

£

No

Yes

No

Yes

No

Yes

Do you have any weeks when you do not have to pay rent?

Are you behind with your rent?

Who pays the Council Tax on your home?Please tick the appropriate box.

You and your partner

Your landlord

Someone else

Do you pay water charges direct to the water authority?

Are you living away from this address at the moment?

Tell us why you are not living there.

When did you last live there?

When do you expect to go back there?

Tell us the address of where you are living at the moment.

Is this address in Great Britain (Wales, England or Scotland)?

If your home has been sublet, tell us who lives there now.

How many?

By how much?

By how many weeks?

Tell us who pays the Council Tax.

Postcode:

/ /

/ /

7

Part 4 About rent - continued

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

£

£

£

£

£

£

£

£

£

£

£

£

No

Yes

How much?

Which mealsare included?

How much?

How much?

How much?

How much?

How much?

How much?

How much?

How much?

How much?

How much?

How much?

If ‘Yes’, do you have to rent the garageor parking space as part of your tenancyagreement?

Does your rent include money for the following?

Meals

Heating

Lighting

Hot water

Fuel for cooking

Laundry

General counselling and support

Emergency alarm

Room and window cleaning

Central heating

Internal decoration

Gardening

Garage or parking space

8

Part 4

Part 5

About rent - continued

About where you live

Postcode:

Postcode:

No

Yes

What is your landlord’s name and address?By landlord we mean the person or organisation who owns the property you live in.

If your landlord has an agent, tell us their name and address.By agent we mean the person or organisation you actually pay your rent to.

Are you, your partner or children related to your landlord or agent, or to your landlord’s partner or your agent’s partner?Related includes related through marriage, even if the marriage has ended.

What sort of building do you live in?

How many fl oors are there?

Do you and your household occupy only part of the building you have listed above?

Which fl oors do you live on?

No

Yes

What is the relationship?

We must see proof of your rent and tenancy before we can decide how much benefi t you can get. Read the checklist at Part 17 to see what you can use as proof.

Detached house

Semi-detached house

Terraced house

Maisonette

Bungalow

Other

Flat in house

Flat in block

Flat over shop

Bedsits or rooms

Hostel

Board and lodgings

Hotel

Caravan, mobile home or houseboat

Residential nursing home

Residential care home

As you look at the building from the street, where in the building do you live?

At the left

In the front

At the back

At the right

In the middle

For example, ground fl oor, fi rst fl oor. 9

Part 5 About where you live - continued

How many rooms are there in the building?

In the whole building?

Just for you and your household?

That you share with other people?

Living rooms

Bedsitting rooms

Bedrooms

Bathrooms

Toilets

Kitchens

Other rooms

Do you use your home for business?

Please tell us if you have any special needs that require you to rent a home of this size.For example, special needs that mean either you or your partner or one of your children is unable to share a room.

No

Yes

No

Yes

No

Yes

Does anyone in your household have a carer that stays overnight?

If Yes

Do they have their own bedroom?

Who do they provide care for?

Why is the care required?

How often does the carer stay?

10

Part 5 About where you live - continued

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

Part 6 About Income Support, Jobseeker’s Allowance (income-based), Employment and Support Allowance (income-related) or Pension Credit

Postcode:

£

Do you have a main home somewhere else?If your main home is somewhere else in the UK or abroad, tick ‘Yes’, even if you do not pay rent on it.

What is the address?

How much do you pay for this home?

Answer both the questions in this part, then go to Part 7.

Go to Part 7.

You Your partner

When did you start getting it?

When did they start getting it?

When did you claim?

When did they claim?

Are you or your partner getting or waiting to hear about a claim for Income Support, Jobseeker’s Allowance (income-based), Employment and Support Allowance (income-related) or Pension Credit?

Are you or your partner getting Income Support, Jobseeker’s Allowance (income-based), Employment and Support Allowance (income-related) or Pension Credit?

Are you or your partner still waiting to hear about a claim for Income Support, Jobseeker’s Allowance (income-based), Employment and Support Allowance (income-related), or Pension Credit?

/ /

/ /

/ /

/ /

11

Part 7 About being self-employed

Are you or your partner self-employed?

No

Yes

No

Yes

You Your partner

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

£ £

£ £

Are you or your partner a company director?If you are, the business will have been registered with Companies House.

Answer the questions on this page.You must send us your trading accounts for the last fi nancial year. Your HMRC self-assessment form is not acceptable as proof of your self-employed income.If you have only recently set up the business and do not have a full year’s accounts, we will need to see some other proof of your income. We will write to you about this.

Go to Part 8.

What kind of work do you do?

When did the business start?

What is the business address?

Are there any other partners in the business?

How many hours a week do you work?Do you get a Business Start-up Allowance?

Do you pay into a private pension scheme?

Postcode:

Postcode:

Postcode:

Postcode:

Tell us their name and address.

We will write to you about this.

Tell us their name and address.

How much? How much?

How often? How often?

How much? How much?

How often? How often?

Every Every

Every Every

We must see proof of any income before we can decide how much benefi t you can get. Read the checklist at Part 17 to see what you can use as proof.

/ / / /

12

Part 8 About working for an employer

No

Yes

Go to Part 9.Answer the questions on this page. If you work for more than one employer, tell us about all the employers on another piece of paper and send it with this form.

Do you or your partner work for an employer?


What is your employer’s name and address?

When did you start this job?

Are you employed for a limited period?

Postcode: Postcode:

How often do you get paid?

How much do you get paid?

How are wages paid i.e. bank account?

When was your last pay rise?

When will your next pay rise be?

How many hours a week do you usually work?Are you getting Statutory Sick pay (SSP) or Statutory Maternity pay (SMP) from your employer at the moment?

Do you pay into a private or company pension scheme?

If Yes, when did this start?

Are you getting any other sick pay or maternity pay from your employer at the moment?

We must see proof of any earnings before we can decide how much benefi t you can get. Read the checklist at Part 17 to see what you can use as a proof. If you get tips or bonuses, tell us about these in Part 15.

You Your partner

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes


Every Every

When will you fi nish?

When will theyfi nish?

£ £

Every Every

How much? How much?

£ £

/ /

/ /

/ /

/ /

/ / / /

/ / / /

/ / / /

13

No

Yes

Go to Part 10.

You Your partner

Do you or your partner do any other work at all?This could be voluntary work or any other work, even if it’s not paid work.


Part 9 About any other work

Postcode:Postcode:

What is the name and address of the person you do this work for?

When did you start this work?

How many hours a week do you work?

Do you get paid?If you only get expenses or tips, still tick ‘Yes’ and give details.

When will your next pay rise be?

Answer the questions on this page.

No

Yes

No

Yes

We must see proof of any earnings before we can decide how much benefi t you can get. Read the checklist at Part 17 to see what you can use as proof.

£ £

How much? How much?

Every Every

/ / / /

/ / / /

14

Part 10 About benefi ts and pensions

Are you or your partner getting any benefi ts or waiting to hear about benefi ts you have claimed?Read the list of benefi ts and tell us about any you or your partner are getting now or have claimed.

No

Yes

Go to Part 11.

Tell us about the benefi ts below.

£ £

How much? How much?

£ £

How much? How much?

£ £

How much? How much?

You Your partner

Every by Every by

Every by Every by

Every by Every by

How often and by what method? How often and by what method?



We need to see proof of any benefi ts before we can decide how much benefi t you can get. Read the checklist at Part 17 to see what you can use as proof.


The name of the benefi t or pensionWaiting to hear

Getting now


Getting now


Getting now

If you are getting or have claimed any benefi t that is not listed, tell us about it on a separate piece of paper and send it with the form.

• Attendance Allowance• Adoption Pay• Bereavement Allowance• Bereavement Support Payments• Carer’s Allowance• Child Benefi t• Child Tax Credit• Disability Living Allowance• Employment and Support Allowance (Contribution based)• Fostering Allowance• Guardian’s Allowance• Incapacity Benefi t• Industrial Injuries Disablement Benefi t• Industrial Death Benefi t

• Jobseeker’s Allowance (Contribution based)• Maternity Allowance• Pension Credit• Personal Independence Payment• Retirement Pension• Severe Disablement Allowance• Statutory Maternity Pay• Statutory Paternity Pay• Statutory Sick Pay• Universal Credit• War Disablement Benefi t, War Pension or War Widow’s Pension• Widow’s or Widower’s Benefi ts• Working Tax Credit• Any other social security benefi t

15

Part 11 About other money coming in

No

Yes

Go to Part 12.

Answer the questions on this page.

Do you or your partner, or any children you are claiming for, have any money coming in that you have not already told us about on this form?

This includes occupational pensions, student income such as grants, loans or bursaries, maintenance or child support for you, your partner or any of the children you are claiming for; and any cash payments. Also tell us about any money you get from people living in your house as boarders, lodgers or subtenants. You do not need to tell us about payments from the Independent Living Fund, the Eileen Trust or the MacFarlane Trust.

£

Every

£

Every

£

Every

No

Yes

£

What for?

How much?

We must see proof of any income before we can decide how much benefi t you can get. Read the checklist at Part 17 to see what you can use as proof.

Does anyone owe money to you, your partner, or any children you are claiming for?

What is the money for?

Who gets it?

How much do they get?

How often?


Who gets it?


How often?


Who gets it?


How often?

Other money 1

Other money 2

Other money 3

16

Part 12 About bank accounts, savings, investments and property

Go to Part 13.Do you or your partner have any savings, investments or own or partly own any land or property other than the home you live in?This includes current accounts and savings accounts with a bank or building society, post offi ce accounts, premium bonds or stocks and shares.

Do you or your partner have any bank accounts?

Answer all the questions in this part. We must see proof of all the capital, savings and investments. Read the checklist at Part 17 to see what you can use as proof.

No

Yes

No

Yes


No

Yes

Do you or your partner have any building society accounts?

Tell us about any bank accounts. If there are more than 2 bank accounts, tell us about the others on a separate piece of paper and send it with this form.

Tell us about any building society accounts. If there are more than 2 building society accounts, tell us about the others on a separate piece of paper and send it with this form.


We need proof of all your accounts, even those with little or no money, or this may delay paying your benefi t.

£

£

£

£

Name of bank Account number

Whose name is the account in? How much is in the account?

Name of bank Account number




Name of building society Account number

Name of building society Account number

17

No Yes

Part 12 About bank accounts, savings, investments and property - continued

No

Yes

No Yes



We need proof of all your accounts, even those with little or no money, or this may delay paying your benefi t.

Value?

Value

Value

How many?

How many?

How many?

How many?

Issue number

Issue number

Company name

Approximate value

Approximate value

Company name

£

£

£

£

Tell us about any post offi ce accounts. If there are more than 2 post offi ce accounts, tell us about the others on a separate piece of paper and send it with this form.

Do you or your partner have any post offi ce accounts?This includes savings accounts and Girobank accounts.



Type of account Account number


£

£

£

Tell us about any National Savings Certifi cates. If you have more than 2 issues, tell us about the others on a separate piece of paper and send it with this form.

Do you or your partner have any Premium Bonds?

Do you or your partner have any National Savings Certifi cates?

Do you or your partner have any stocks, shares, bonds or unit trusts?

18

No Yes

Part 12 About bank accounts, savings, investments and property - continued

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes





£

£

Tell us about this.


What payment did you receive?A Far Eastern Prisoner of War Compensation payment.


Do you or your partner have any other capital, savings or investments?Tell us about any ISAs here.

Do any of you or your partner’s savings or investments include:• Money from the sale of a house, or• Money from a charity

Do you or your partner have any other savings or investments?

Apart from your home, do you or your partner own any other property or land in this country or abroad?If it is on a mortgage or a loan, still tick ‘Yes’.

Have you or your partner received a payment from the CJD (Creutzfeld-Jakob Disease) Trust?

Have you or your partner received:• A Far Eastern Prisoner of War Compensation payment, or• A compensation payment made to victims of atrocities that happened during the Second World War?

We need to know this to make sure we do not count it as part of your savings.

You

You

Your partner

Your partner

Who received the payment?

A compensation payment made to victims of atrocities that happened during the Second World War.


19

Part 13 How will you be paid

How do you want us to pay your Housing Benefi t?We can pay your Housing Benefi t straight into your bank or building society account or in certain cases straight to your landlord.

I want my benefi t to go straight into my bank or building society account.

Name of bank or building society

Address

Whose name is the account in?

Account number

Sort code

I want my benefi t to go straight to my landlord.

Payments direct into a bank or building society account is the safest way to pay your Housing Benefi t.

• If you are a tenant of a private landlord, your Housing Benefi t will be paid to you.

You cannot choose to have your Housing Benefi t paid to your landlord, but if there is a reason why you cannot manage your own payment you should tell us why on a separate sheet of paper. You will normally need to supply evidence from, for example your Doctor, Support Worker or a Welfare Organisation confi rming the reasons why you cannot manage.

• If you are a tenant of a Housing Association, your Housing Benefi t will be paid to you unless you choose to have it paid to your landlord.

• If you are a council tenant, your Housing Benefi t will be paid into your rent account.

• If you are awarded Council Tax Reduction, this will be paid into your Council Tax account.

Tell us the following details.

Postcode:

Please make sure this account is included in Part 12 of this form.

Private tenants cannot choose to have payments made to their landlords.

20


Part 14 Sharing information

I give The City of Cardiff Council Benefi t Section permission to share information about the progress of my Housing Benefi t and/ or Council Tax Reduction claims with my landlord or a representative acting on my behalf.

Sharing information with your landlord or representative could help us deal with your claims quicker and reduce the risk of you falling behind with your rent and/ or Council Tax. It will not affect your claim if you do not wish to give us permission to disclose details of your claim to your landlord. You can also withdraw your permission at any time.

If you give us permission, we would be able to tell your landlord or representative:• If you have claimed Housing Benefi t and/ or Council Tax Reduction• If we have made a decision on your claim and what the decision is• If we need more information to make a decision on your claim• When a payment was made, the period the payment was for and the amount of the payment• If your claim has ended or has been suspended

We would also write to your landlord to advise that your claim has been completed and the date payment will be sent.

We will not give your landlord or representative any information about your fi nancial or personal circumstances.

If you do not give us permission we will only share information with your landlord if your benefi t is paid directly to them. We will tell them the amount of benefi t to be paid, the period that it covers and the date it is due to be sent.

We would not be able to give information to a representative who may be acting on your behalf if you do not give us permission.

To give us permission to discuss your claims with your landlord or representative, please sign below.

Customer Signature

Landlord’s name Representative’s name

Organisation

21

Address

Tel:

Address

Tel:

Part 15 Anything else you need to tell us

If you are sending a separate sheet of paper, tick this box.Use this box to tell us anything else you think we should know about. Use a separate sheet and attach it to this form if you need to.

Part 16 Backdating

No

Yes

Why have you not claimed before?

Date you want to claim benefi t fromDuring this earlier period, were your circumstances different to those you have told us about on this form?

What has changed?We need proof of changes in your circumstances for this period.

If you need more space, send a separate sheet of paper and tick this box.

Please tell us about it below.

We will normally award you Housing Benefi t from the fi rst Monday after we receive your form and Council Tax Reduction from the day we receive your form. If you want us to pay you from an earlier date, fi ll in the boxes below.You need to tell us:

• Why you did not claim earlier. We can only backdate if you have good reasons why you did not claim earlier.• The date you want to claim from. If you have good reasons why you did not claim earlier, we will normally pay you Housing Benefi t from the fi rst Monday after this date and Council Tax Reduction from the actual date.

/ /

22

Part 17 Checklist

Please tick to tell us what proof you are sending with this form. We must see original documents, not copies.

If you do not provide all the proof we need, we might not be able to pay you any benefi t. We need the same proof for your partner, if you have one, and for any adults living in your home.

If you cannot send the proof we need at the moment, send the form back to us now and send the proof later. We can start to process your claim, but we will not be able to pay you any benefi t until we have all the proof.

Please do not send valuable items through the post. If you can, bring them into one of our local Hubs. We will take the details we need and give you the documents back straight away. If you cannot get into a Hub, phone us for more advice.

Proof of identityWe need to see at least 2 of these documents for each person, and one of the documents must show the National Insurance number.Such as a:• Birth certifi cate;• Marriage certifi cate;• Passport;• National Insurance Number card;• Medical card;• Driving licence; • UK residence permit; • EEA identity card; or• Recent gas or electricity bill.We need to see at least 2 of these documents for each person.

Proof of bank accounts, savings, investments and propertyThis means:• All your bank, building society or post offi ce books, or certifi cates for premium bonds; • Your bank statements, showing details for the last 2 months, printouts from internet banking are acceptable; • National Savings Certifi cates; or• ISAs, stocks, shares and unit trusts.We need to see proof of any interest or dividends you get on investments and savings.

Proof of earningsThis means your last 5 payslips if you are paid every week, your last 3 payslips if you are paid every 2 weeks, or your last 2 payslips if you are paid every month. If you do not have these payslips, ask your employer to fi ll in the certifi cate of earned income on page 27. If you or your partner are self-employed, we need to see your accounts, preferably audited by your accountant for the last fi nancial year or, if you have been trading for less than 6 months, a summary of your trading records so far.

Proof of other incomeSuch as pension slips from a former employer. We need to see proof of any money people pay you for board and lodgings.

Proof of benefi ts, allowances or pensionsSuch as award notices or letters from social security confi rming how much you get. If you do not have proof, let us know straight away.

Proof of private rent and tenancySuch as a tenancy agreement with either rent receipts, consecutive bank statements showing rent paid, your rent book or a letter from your landlord or agent. The letter or rent book should show the rent paid so far or the outstanding arrears. You may also ask your landlord to fi ll in the proof of rent form on page 29. If you have to send the proof of rent form to your landlord to fi ll in, do not delay in sending the rest of the form back to us.

Proof of other money paid outSuch as letters about student grants or maintenance, agreements or receipts from registered child carers.

23

Language Preference/Dewis laith

We would be grateful if you could confi rm whether you would like to receive future correspondence from us in English or Welsh.English Welsh

Byddem yn gwerthfawrogi pe gallech ymateb i gadarnhau a hoffech gael gohebiaeth gennym yn Saesneg neu’n Gymraeg yn y dyfodol.Saesneg Cymraeg

Part 18 Declaration

Even if someone else has fi lled in this form for you, you must sign this declaration if you can. If you have a partner, getting them to sign this form should allow us to process your claim more quickly, but they do not have to sign.

Signature of person claiming

Date

Partner’s signature

Date

If this form has been fi lled in by someone other than the person claiming:

Please tell us why you are fi lling in this form for the person claiming.Name of the person who fi lled in the form

Signature of the person

Relationship to the person claiming

Date

Please read this declaration carefully before you sign and date it.• I understand that this claim is made to you, The City of Cardiff Council.• I declare that the information I have given on this form is correct and complete as far as I know and believe.• I understand that if I knowingly give information that is incorrect or incomplete, I may be liable to prosecution or other action.• I agree that you will use information I have provided to process my claim. You may check this information with other sources such as other sections of the Council, other Councils, or my employer. (This list is not exhaustive.)• I understand that you may use any information I have provided in connection with this and any other claim for social security benefi ts 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, if the law allows this.• I know that I must let you know in writing straight away about any change in my circumstances which may affect my claim.

This authority is under a duty to protect the public funds it administers, and to this end may use the information you have provided on this form for the prevention and detection of fraud. It may also share this information with other bodies responsible for auditing or administering public funds for these purposes.

For further information, see our Fair Processing Notice Condensed Text at www.cardiff.gov.uk/fraud and the Fair Processing Notice Full Text on the Wales Audit Offi ce website www.wao.gov.uk/whatwedo/1252.asp Or contact:Information Manager, County Hall, Cardiff, CF10 4UWTelephone: 029 2087 3346. Fax: 029 2087 3349

/ /

/ /

/ /

24

QuestionnaireUnder the Race Relations Act we have a responsibility to gather details of our clients’ backgrounds. This information is used to help us with our equal opportunities policies.

This information is confi dential and will be used only to improve access to our services and help provide equal opportunities for everyone.

The completion of this survey is voluntary.

No YesNationalityDo you consider yourself to be Welsh?

Ethnic OriginWhich background do you feel you belong to?

White

British

Irish

European

Other whitebackgroundplease specify

Black

African

African Somali

British

Caribbean

Other blackbackgroundplease specify

Asian

Bangladeshi

British

Indian

Pakistani

Sri Lankan

Other Asianbackgroundplease specify

Mixed Ethnic Background

White and Asian

White and Black African

White and Black Caribbean

Other mixed ethnicbackgroundplease specify

Other GroupsArab

British Chinese

Chinese

Czech

Gypsy Traveller

Japanese

Korean

Polish

Somali

Yemeni

Other background

please specify

Any Other Ethnic Background

Any other ethnicbackgroundplease specify

25

The City of Cardiff CouncilHousing Benefi t/Council Tax Reduction/Free School Meals Certifi cate of Earned IncomePlease give the form to your employer to complete.

We may contact your employer direct if we have a query with the information provided.

Employee details (person claiming benefi t)

Employer details (who you work for)

Income details

Employee’s name

Employee’s number

Occupation

Employee’s address including postcode

Telephone number

Name

Position

Business name and address

Employer’sauthorisation stamp or attach a letterhead

Telephone Number

Date employment started

Date employmentended (if applicable)

Tax Code

National InsuranceNumber

Normal basic pay

Date of last payincrease

Date of next expected increase

Do they currentlyget sick pay ormaternity pay?

If ‘Yes’, what do they receive?

When did it start?

When is it due to expire?

Yes

No

Sick Maternity

£ per

per weekNormal hours

How are theypaid?

How often are they paid?

by cash

by cheque

into a bank account

other (please detail)

every week

every two weeks

every four weeks

every month

other (please detail)

/ /

/ /

/ /

/ /

/ // /

27

£

Recent IncomeIn the table below, please give details of the employee’s last 5 payslips if paid weekly, last 2 payslips if paid monthly and last 3 if paid fortnightly. Include any overtime, bonuses, commission and so on.

If ‘Yes’, please show the total earnings and deductions for the last 13 weeks or 3 months (or if they have not been employed that long – as long as possible). Include any overtime, bonuses, commission and so on.

Please complete this section if your employee has started work in the last two months.

Have normal hours been worked since starting work?

If ‘No’, what hours are they currently working and when will they start normal hours?

Is your employee expected to earn any additional money on top of their normal wages? e.g. bonuses, regular overtime, etc. If so, please provide details.

The information I have given the Council is true and complete.

Pay period starting

Pay period ending

Number of hours worked

Payments

Deductions

Net Payment

Gross earnings

Sick pay

Overtime

Maternity pay

Other payments(please detail)

Tax

National Insurance

Pension

Do your employee’s earnings vary a lot?

Signature

Date

Yes No

Please post this form to:FREEPOST CARDIFF COUNCIL HOUSING BENEFITPO Box 6000Cardiff CF11 0WZ

If your employee has recently started work

Declaration What to do now

Payment 1 Payment 2 Payment 3 Payment 4 Payment 5

Year To Date

Year To Date

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

Period start

£ £ £ £

Period end Hoursworked

GrossPayments

Tax NationalInsurance

PensionContributions

Yes

No

/ // /

/ // /

/ // /

/ // /

/ // /

/ / / /

/ /28

£

The City of Cardiff CouncilProof of Rent Form(For your landlord or agent to fi ll in)

Tenant details

Landlord and tenancy details

Landlord and tenancy details - continued

I would be grateful if you could help your tenant by fi lling in this form and returning it to me.

Tenant’s name

Address and postcode

Name


Name


Landlord’s details

Agent’s details

Tenancy details

Please tell us about your agent if you have one.

How much rent do you charge for each tenant if it is a joint tenancy?How often is the rent due?

Has the rent offi cer registered a fair rent?

Are you related to the tenant, their partner or their children?

Is this a tenancy where the agent only acted for a fi nding fee?

Date the tenant moved inDate the tenancy startedHow much rent do you charge?

Is there a joint tenancy?

Declaration

Declaration fordirect payments

What to do nowPlease post this form to:

Signature

Date

Signature

Date

FREEPOST CARDIFF COUNCIL HOUSING BENEFITPO Box 6000Cardiff CF11 0WZ

Services

As far as I know, the information I have given is correct. I will write to you immediately if I know that my tenant’s circumstances have changed.

I will accept Housing Benefi t for this tenant. If you pay me too much, I understand you may ask me to pay it back and take me to court if I don’t. I will write to you immediately if I know that my tenant’s circumstances have changed.

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

Is the tenant behind with their rent?

Does your rentinclude money for any of the following?

Meals

By how much

By how many weeks?

Heating

Lighting

Gardening

Water rates

Hot water

Emergency alarm

Fuel for cooking

Room and window cleaning

General counselling and support

Laundry

Central heating

Internal decorating

Garage or parking space

Other Pleasespecify

No Yes

Relationship

Number of tenants

No

Yes

£

£

Please send us the notice of registration form R05.

(weekly/ 2 weekly/ 4 weekly/ monthly)

/ // /

/ /

/ /

29

No Yes

No Yes

No Yes

The City of Cardiff Council

Housing Benefi t/Council Tax Reduction/Free School Meals Change of Circumstances Form

Please keep this form and return it to the Benefi ts Section with details of any changes in your circumstances.

I understand that if I give information that is incorrect or incomplete, you may take action against me. This may include court action.

I declare that the information I have given on this form is correct and complete.

How to return this form:• By post to: FREEPOST CARDIFF COUNCIL HOUSING BENEFIT, PO Box 6000, Cardiff CF11 0WZ • In person to: any of the Hubs shown on the ‘Contact information’ page.• Or contact us on: 029 2087 2087 for a Hub near you.

You will need to provide proof of the change. Please provide original documents as we do not accept photocopies.

Return this form immediately, do not delay telling us about the change even if you do not yet have the proof.

Postcode:

Name

Address

Telephone Number

Claim Reference

Date of Change

Details of Change(continue of a separate sheet if necessary)

Signature

Date

If you are not the claimantplease complete this section:Name

Relationship to claimant /organisationTelephone Number

/ /

/ /

31

Changes in Circumstances

You must tell the Council’s Benefi t Section about any changes in your circumstances that could change the amount you receive.

The changes you should tell us about include, but are not limited to:

• If you change address • If you or your partner start work, change job or have a pay increase • If there is any change to any income that you or your partner receive • If any welfare benefi ts change such as tax credits • If Jobseeker’s Allowance or Income Support stops • If one of your children changes or leaves school • If you or your partner has a baby • If anyone moves in or out of the property, even on a temporary basis • If you have a new partner or become married or separated • If your savings change, but only if they are above £6,000 in total • If you start or stop paying childcare costs if the amount changes • If your rent changes (unless you are a Council tenant) • If anyone in your home has a change of circumstances such as the ones listed above

If you are required to register your employment with the Home Offi ce remember to tell them if you change your job and tell us too.

Please note these are just examples and you should tell us about any change that might affect your benefi t straightaway. If you are not sure, please contact us for advice.

You must tell the Council’s Benefi ts Section about the changes. Do not rely on someone else to pass the message on and do not just tell the Job Centre or the Pension Service.

If It’s New Tell Us Too!

Overpaid Benefi t

If you delay in telling us about a change of circumstances an overpayment of benefi t may result. You will have to pay this money back and legal action may be taken if you do not do so.

You may be prosecuted if you deliberately fail to declare changes in your circumstances.

If you have diffi culty in understanding this form, help is available in many languages at the Hubs.

Vers

ion

14 -

Janu

ary

2017

32

The City of Cardiff CouncilContact Information

Returning your form and making enquiries

You can send your form to us at:

You can return your form and make enquiries at any of these Hubs and other offi ces.

FREEPOST CARDIFF COUNCIL HOUSING BENEFIT PO Box 6000 Cardiff CF11 0WZ City Centre Central Library Hub029 2087 1000 Second Floor, Central Library, The Hayes CF10 1FL Open: Monday to Wednesday 9am to 6pm, Thursday 10am to 7pm, Friday 9am to 6pm, Saturday 9am to 5.30pm. Canton Canton Library, Library Street, Canton CF5 1QD029 2078 0999 Open: Tuesday 9am to 1pm & 2pm to 6pm.

Llandaff Llandaff North & Gabalfa Community Hub029 2078 5588 Gabalfa Ave, Llandaff CF14 2HU Open: Mon & Tues 9am to 6pm, Wed 10am to 5pm, Thursday 10am to 7pm, Friday 9am to 6pm, Saturday 9am to 5.30pm

Llanedeyrn The Powerhouse, Maelfa, Llanedeyrn CF23 9PN029 2054 9650 Open: Mon, Tues and Thurs 9am to 6pm. Wednesday 10am to 7pm, Friday 9am to 6pm and Saturday 9am to 5.30pm.

Llanrumney Hub Llanrumney Library, Countisbury Avenue CF3 5NQ029 2078 0994 Open: Monday to Thursday 9am to 6pm, Friday 10am to 7pm, Saturday 9am to 5.30pm.

Ely & Caerau Hub Cowbridge Road West, Ely CF5 5BQ029 2087 3800 Open: Monday to Wednesday & Friday 9am to 6pm, Thursday 10am to 7pm, Saturday 9am to 5.30pm.

Splott Star Community Hub, Muirton Road CF24 2SJ029 2078 8505 Open: Monday & Tuesday 9am to 6pm, Wednesday 10am to 7pm, Thursday and Friday 9am to 6pm, Sat 9am to 5.30pm

Fairwater Hub Doyle Avenue, Fairwater CF5 3HU029 2078 5583 Open: Monday 9am to 6pm, Tuesday closed, Wednesday 9am to 6pm, Thursday 10am to 7pm, Friday 9am to 6pm, Saturday 9am to 5.30pm

St Mellons Hub 30 Crickhowell Road, St Mellons CF3 0EF029 2078 0994 Open: Monday to Wednesday 9am to 6pm, Thursday 10am to 7pm, Friday 9am to 6pm, Saturday 9am to 5.30pm.

Butetown Hub Plas Iona, Loudoun Square, Butetown CF10 5HW029 2053 7060 Open: Monday & Tuesday 9am to 5pm, Wednesday 10am to 6pm, Thursday & Friday 9am to 5pm.

Rumney Llanstephan Road, Rumney, CF3 3JAPartnership Hub Open: Mon to Wed 9am to 1pm & 2pm to 6pm, 029 2233 0661 Thursday 10am to 1pm & 2pm to 7pm, Friday closed, Saturday 9am to 5:30pm.

Grangetown Hub Havelock Place, Grangetown, CF11 6PA029 2078 0966 Open: Monday & Tuesday 9am to 6pm, Wednesday 10am to 7pm, Thursday & Friday 9am to 6pm, Saturday 9am to 5.30pm.

Please note that Council offi ces are closed on public holidays.

Home Visit ServiceIf you need help to fi ll in your form and you are not able to come into any of the Hubs, please contact us to arrange a visit on 029 2053 7380. If you are a Council tenant, please call 029 2023 4200.

You can e-mail us at:

Our website is:

benefi [email protected]

www.cardiff.gov.uk/benefi ts

Phone enquiries: You can phone Connect 2 Cardiff on 029 2087 2087.

Rent enquiries for Council tenants:

You can e-mail us at:

029 2053 7350

[email protected]

Housing Association tenants:

Free School Meals:

If you are a tenant of one of the Housing Associations listed below, you can return your form to your Housing Association offi ce. They will then send it on to us. See your Housing Association’s website for details of how to contact them.

For enquiries about Free School Meals, please contact:

Phone: 029 2053 7250

E-mail: [email protected]

Cadwyn Housing Association

Cardiff Community Housing Association

Hafod Housing Association

Linc Cymru Housing Association

Taff Housing Association

United Welsh Housing Association

Wales and West Housing Association

Newydd Housing Association

www.cadwyn.co.uk

www.ccha.org.uk

www.hafod.org.uk

www.linc-cymru.co.uk

www.taffhousing.co.uk

www.unitedwelsh.com

www.wwha.co.uk

www.newydd.co.uk

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