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: