1. Council Tax Reduction - Exceptional Hardship Fund

  2. Section 1 - Personal Details
  3. Address lookup
  4. Please provide your last 3 months statements for all bank/building society accounts held as evidence of your outgoings.

  5. Section 2 - Weekly Outgoings
    1. Other (Please Give Details)
    2. Group2
    3. Group2
    4. Group2
    5. Group2
    6. Weekly Outgoings Calculator
  6. Section 3 - Weekly Income
    1. Other (Please Give Details)
    2. GROUP7
    3. GROUP8
    4. GROUP9
    5. GROUP10
    6. GROUP11
    7. GROUP12
    8. GROUP13
    9. GROUP14
    10. Weekly Income Calculator
  7. 1. Why do you need this extra help?
    1. Tell us about your weekly income within the household and the way you spend it.

      • Can you get help towards the shortfall in your housing costs from other members of your family?

      • What sort of contribution are you prepared to make, to meet the shortfall?

      • Tell us about any debts you have and how much they are, including any rent or Council Tax Arrears (provide evidence of any rent arrears).

    2. Based on your budget, what is the most you can afford to pay towards your rent?

      £ a week

      Based on your budget, what is the most you can afford to pay towards your Council Tax bill?

      £ a month

  8. 2. What are your family circumstances?
    1. Tell about any disabilities, health problems, special needs etc. for you or your family. Has your property been adapted to assist with any disability? If you receive DLA or PIP how do you spend this money? (continue on a separate sheet of paper if necessary).

    2. If you own your property and are applying for help with your Council Tax only go straight to Question 6. Declaration

  9. 3. What have you done to help yourself? Have you received any debt advice? What was the outcome of any advice?
    1. Tell us if you have tried to re-negotiate the rent with your landlord, you have looked for cheaper accommodation or signed up with Devon Home Choice. Is there a particular reason why you cannot move, were you aware that your rent would not be met in full when you accepted the tenancy and if so, how you had planned to meet it. Have you sought any debt advise and if so where from?

  10. 4. Is there anything else that you can tell us about your need for a exception hardship payment?
  11. 5. Declaration
    1. Please check that you have completed the form accurately and then read and sign the following declaration.

      I understand all of the following:

      • If I give information that is incorrect or incomplete you may take action against me. This may include court action.

      • You will use the information I have provided to check my claims for Discretionary Housing Payments, Council Tax Reduction / Housing Benefit. You may check some of the information with other council records and with other councils.

      I know that I must let the Benefits Team know about any changes in my circumstances that may affect my claim.

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

      I give permission to pass on my details to third party agencies for assistance with debt and money advice.

      Please tick to confirm if you agree with the above statement:   

    2. If someone else has helped you complete this form, please give their details here: