Housing benefit/council tax reduction appeal

ContactId

What would you like us to do? (Please tick one of the following)

Send you a statement of reasons
(we will send you a full written explanation of our decision within 1 calendar month).Look at your claim again
(We will look at your claim again and revise our decision if we think it is wrong. We aim to do this within 1 calendar month).Refer your Housing Benefit case to the Tribunals Service
(We will look at your claim again and if we cannot change it, we will forward your papers to HM Courts and Tribunal Service. If this is the case, we will need handwritten signature from you. You will need to print this form and sign it and return it by post. If you do not have access to a printer we will issue you with a copy of the form to sign.)
N.B. HM Courts and Tribunal service is an agency of the Ministry of Justice and is wholly independent of the council. It can take several weeks for your case to be heard.

Are you completing this appeal on behalf of someone else?

Yes

Details of person completing the form

Full name

Address

Contact number

Claimant details

Full name

Address

Contact number

Appeal details

Benefit reference number

Please state which decision you are appealing against

Housing Benefit

Council Tax Reduction

Both

Date of the decision letter

You must say why you think the decision is wrong. It is not enough to say "I do not agree with the decision" or "I need more money".

If you are appealing against more than one decision you must say why you do not agree with each one.

If you want us to look at your claim again or are appealing more than one month after the decision was made, you must say why this has been delayed.

Details

Declaration

You must read the undertakings below which you are promising to the Council carefully and make sure that you understand their contents before completing and submitting your application form (by ticking each box you agree to its contents).

I declare that all the information I have given in this application form is entirely accurate and complete. I understand and accept that if I give any information that is inaccurate or incomplete, action may be taken against me (including by way of legal proceedings).

I agree that the Council may check the information I have given on this application with third parties (to the extent allowed by the law).
I agree that I must let the Council know immediately in writing (which may include notification on-line and/or by email) about any changes in my circumstances and those contained in the application form which might affect my award.
I agree that the Council may at its discretion share relevant data with third parties, including but not limited to Government departments, local authorities and private sector companies such as banks and organisations (that may lend me money) in each case to the extent allowed by the law.
I agree that the Council will not be responsible for any inaccuracies I make in completing this form.
I agree that the Council will use the information I have provided to process my application and that it may be shared with other Council departments.

I confirm that all the details I have included on this form are correct and that I understand all the information above.

Please check this box to confirm you have read and agree to the above declaration.

Date