Council Tax Support Claim Form

Crawley Borough Council
Council Tax Support Claim (v3)
ALL QUESTIONS MUST BE ANSWERED
Full Name:
National Insurance Number: Email Address:
DOB: Phone Number:
Current Address:
Post Code:
Date you moved in
Do you OWN or RENT this property? If Own / Rent
neither please explain.
Nationality
Date arrived in UK
Are you subject to immigration control? Yes / No
Do you have a home office card? Yes / No
Previous Address:
Who do you rent the property

from?
Who is the owner of the property?
Do you have any savings or capital? Yes / No
How much in total?
Do you own any other property or Yes / No

land in the UK or abroad? If so
please give details.
Number of other adults who live with you?
Name National Relationship to you DOB Nationality How Long in UK

Insurance
Number
Income You Partner £ Other Other

£ Adult Adult
name name
List frequency weekly / fortnighly / monthly
Housing Benefit
Universal Credit
Working Tax Credits
Child Tax Credits
Income Support
Job Seekers Allowance Income
Based
Job Seekers Allowance
Contribution Based
Child Benefit
Maintenance
Disability Living Allowance / PIP
ESA
Pensions
Other
Other
Earnings (You) Employer Hours p/w Income £ Frequency
Employer 1
Employer 2
Earnings (Partner) Employer Hours p/w Income £ Frequency
Employer 1
Employer 2
Earnings (Non dependant) Employer Hours p/w Income £ Frequency
Employer 1
Employer 2
Earnings (Non dependant) Employer Hours p/w Income £ Frequency
Employer 1
Employer 2
PLEASE PROVIDE THE LAST 5 PAYSLIPS FOR EACH EMPLOYER IF PAID WEEKLY, 3 PAYSLIPS IF PAID
FORTNIGHTLY OR 2 PAYSLIPS IF PAID MONTHLY WITH THIS APPLICATION
Are you / partner self employed? Yes / No (We will need separate accounts)
Are you / partner a company Yes / No (We will need separate accounts)
director?
Are any of the above adults subject to Yes / No

immigration control or have a home
office card?
Are any of the above adults joint Yes / No
tenants or owners of the property?
Number of children who live

with you?
Childs Relationship DOB Nationality How Who Do you receive child maintenance?
Name to you / Long receives
partner in UK Child
Benefit
Do you receive any

disability benefits for the
children such as DLA or
PIP?
Do you pay any child care Yes / No
costs to a registered child Which Child?
care provider? Hours per week?
How much per week?
Ofstead number?
Is any child due to leave
school in the next 2 years?
Is anyone in your household

a student ? Please list when
course started. If Full / Part
time, College / University
and when course is due to
end.
Is anyone in your household
temporarily absent?
Please give details.
Does anyone receive carers

allowance for you?
Any other information you

wish to declare
Is this application been
prompted by a change in
your circumstances triggered
by the Corona-virus?
If yes please supply details.
DECLARATION
Even if someone else has completed this application for you must ask them to read it and the following
declaration back to you, then you must sign and date it.
Please read this declaration carefully before you sign and date it.
 I understand that you may take criminal proceedings against me if;

 I lie to you so that I can get benefit;
 I give you false documents so that I can get benefit;
 I do not tell Crawley Borough Council’s Benefits Section about changes to my circumstances that may affect
my claim; or
 I claim when I know I should not.
I will contact the Benefit Section at Crawley Borough Council about any changes to:
 my income, my partner’s income and the income of anyone else who lives with me;
 my savings and my partner’s savings;
 the number of people who live with me;
 my address;
 my marital or civil partnership status; and
 any other change to my circumstances or the circumstances of any member of my family.
I declare that:
 I understand it is my responsibility to notify Crawley Borough Council’s Revenues Department of any change
in circumstances. I understand that the Department of Work and Pensions will not do this on my behalf if I
notify them of the change;
 I understand that if I fail to inform you of any changes in circumstance within a reasonable period of time,
this could lead to the issue of a penalty notice or the taking of criminal proceedings against me.
 If this application form has been filled in by someone else on my behalf, I have read it, or have had it read to
me;
 The details on the form are true and complete; and
 I have sought permissions from everyone else who lives with me to use their details to process my claim.
 I give you permission to check any information relating to my application for Council Tax Support.
Signature of person claiming:
Date:
Signature of partner:
Date:
Privacy notice
Crawley Borough Council will use the information we hold about you to process your claim for Council Tax Support.
We may pass the information to other agencies or organisations such as the Department for Work and Pensions or
HM Revenues and Customs, as allowed by law.
We may check information you have provided, or information about you that someone else has provided, with other
information held by us.
We may also get information about you from certain third parties, or give them information to:
 Prevent or detect crime;
 Protect public funds; and
 Make sure the information is correct.
These third parties include government departments, local authorities and private-sector companies such as banks,
organisations that may lend you money and companies that assist us in fraud detection and prevention such as
Credit Reference Agencies.
We will not give information about you to anyone else, or use information about you for other purposes, unless the
law allows us to.
Signature:
Date:
If you are the Council Tax payer at your address and wish to claim, please complete and return the attached form
within 1 month of the date of this email/letter.
Alternatively here is a link to the claim form on the website: https://crawley.gov.uk/council-tax-and-benefits/about-

council-tax/council-tax-reduction
Once we have this form back and have received a full breakdown of your Universal Credit / income details, we can
assess whether you would be entitled.
When you receive notification of your Universal Credit payment, please email us the full breakdown (including any
deductions/advances/earned income that are detailed).
If you have a partner or non-dependant (a person over the age of 18) living in the household, please also provide
evidence of their income and your own as follows:
Identity and right to claim:

Evidence of your identity and the identity of others in your household.
Evidence of you and your partner’s national insurance number
Home office biometric card if applicable (both sides)
Capital and Savings:

The last 2 months consecutive monthly statements for all bank or building society accounts held by either you or
your partner. This includes current and savings accounts.
Evidence of any other capital savings or investments including bonds and property or land in the UK or abroad that
you or your partner have.
Income:
Your last 5 weeks or 2 months’ payslips for you or your partner for all jobs held.
If you are self-employed please supply your last year’s full audited accounts.
If you are a director of a limited company please supply your last full year’s director’s accounts, plus your director’s
payslips.
Details of any self-employed income support grant or small business grant received.
Any other income such as:
Child maintenance
Tax credit
Universal credit
Child benefit
Pensions
Disability benefits received by anyone in your household
Any other income.
Once you have gathered these items, you can take photographs or scans of them and email them along with your
completed application form to: benefits@crawley.gov.uk
Please note that if you and or your partner have been furloughed but were previously earning a good wage, it is
probable that you will need to continue paying your council tax, particularly if your total joint earnings are more than
£2500 per month. If you have capital including a second property that amounts to more than £9,000 it is likely that
you will not get any help with your council tax. You can still make a claim, but please do not be disappointed if you
do not qualify.
Please ensure you quote the reference number at the top of this email/letter in any correspondence.
Kind regards
Benefits Team

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Crawley Borough Council

Council Tax Support Claim (v3)

ALL QUESTIONS MUST BE ANSWERED

Who do you rent the property

Who is the owner of the property?

Do you have any savings or capital? Yes / No

How much in total?

Do you own any other property or Yes / No

Name National Relationship to you DOB Nationality How Long in UK

Income You Partner £ Other Other

Are any of the above adults subject to Yes / No

Number of children who live

Do you receive any

Is anyone in your household

Does anyone receive carers

Any other information you

If yes please supply details.

 I understand that you may take criminal proceedings against me if;

Signature of person claiming:

Alternatively here is a link to the claim form on the website: https://crawley.gov.uk/council-tax-and-benefits/about-

Identity and right to claim:

Capital and Savings:

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