Application for Discretionary Housing Payment

Your details

Housing Benefit reference number

Title

First name

Middle names

Last name

Current address

Email

Contact number

Reason for DHP application

If this is a second application, what steps have you taken to improve your situation since you last claimed DHP. Please provide evidence such as properties or jobs that you have applied for

Select the required options

Removal costs

Amount required for removal costs

We may pay up to £100 costs. Please upload a letter from the removal firm stating their costs and bank details so that we can make any payments directly to them

Upload letter from removal company

Rent deposit and/or rent in advance

Amount required for rent deposit and/or rent in advance

£

Rent arrears

Amount required for rent arrears

£

Around what date did you begin to accrue rent arrears

Was there a specific reason

Would you be able to afford your rent, if your rent arrears did not exist?

Yes

No

How do you plan to remain up to date with your rent?

Are you a council tenant

Yes

No

Do you know your rent payment reference?

Yes

No

What is your rent payment reference

If you are a private tenant, do you know the bank details for payment to Landlord?

Yes

No

Landlord's name

Landlord Reference (if known)

Landlord's address (inc postcode)

Landlords name on bank account

Sort code

Account number

Please provide a rent statement from when the arrears began up to date.

Other reasons

Amount required

What will this payment help you with

Evidence should be supplied with this to support your application

Upload supporting evidence

Disability information

Do you or any members of your household have any disabilities or illnesses which you think contribute to higher expenses?

Yes

No

Please provide details and upload any evidence such as a letter from a doctor or hospital

Upload evidence

Has your property been adapted to accommodate any disabilities?

Yes

No

Please provide details.

Capital

Do you or your partner have any bank or building society accounts?

Yes

No

Bank or building society account details

How many accounts?

Account details

Bank/building society name

Account holder

Balance

Do you or your partner have any property or land?

Yes

No

Property/land details

Address of the property/land

The approximate value of the property/land

Do you or your partner have any assets & investments (shares/bonds/cryptoassets/cryptocurrencies etc )?

Yes

No

Asset/investment details

Type of shares/bonds/cryptoassets/cryptocurrencies ?

Account holder

Number of shares/bonds/cryptoassets/cryptocurrencies

Total current value

Please upload the latest statements for all accounts held, we cannot consider an application without this evidence

Application for a rent top up

Did you ask about how much Housing Benefit you would receive before signing

your tenancy?

Yes

No

How did you decide you could afford the 'top up' of rent?

What were your reasons for not checking?

Have you reduced your expenses or looked for cheaper accommodation?

Yes

No

Please provide details

How long do you expect your current circumstances to continue?
If there are any future changes you know about please enter the details.

If you are successful with your application on this occasion, what steps do you intend to take to change your position before the award ends.

Please provide the following bank details as it appears on the account in case an award is successful

Account number

Sort Code

Name

Further Information

Please enter any additional information that may help to support your application.

For example: if you have taken steps relating to the management of your debts please explain your action - contacted CAB etc

Evidence

We will need to see proof of the information you have provided for us in the form.

If you have not already provided a rent statement from when the arrears began up to date, please send to the address below.

If there is any evidence you cannot provide electronically, then please post it to Civic Centre, Castle Hill Avenue, Folkestone, Kent, CT20 2QY, United Kingdom.

Please upload any additional information to support your application here

Declaration

This is my claim for Discretionary Housing Payments. The decision whether or not to award Discretionary Housing Payment will be based on the information I have supplied. I will report any changes in circumstances likely to affect this award immediately to the Benefits office at Folkestone & Hythe District Council.

I understand that Discretionary Housing Payment is a short term emergency fund. It is not and should not be considered as a way round any current or future entitlement restrictions set out within the Housing Benefit, Council Tax Reduction or Universal Credit Legislation.

Confirmation

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

Date

Full name

We will use the information you give in this form and any supporting evidence you send us, to process applications for Housing Benefit (including Discretionary Housing Payments) and Council Tax Reduction or to determine Council Tax liability.

We may pass the information to other internal council departments and external agencies or organisations such as the Department for Work and Pensions, the Jobcentre Plus and HM Revenue and Customs, as allowed by the law.

Rent you pay (the amount not covered by benefit)	Council Tax you pay
Food, Toiletries & Cleaning Products	Internet/Broadband
Mobile	Personal Insurance
Home insurance	Water rates
Gas	Electricity
Other household fuel	TV Licence
Maintenance / Child Support	Car - Petrol
Car - Insurance	Car - Tax
Car - Maintenance	School dinners
Clothing / School Uniform	Childcare
Child clubs	Public Transport
Other

Armed Forces Independent Payment	Attendance Allowance
Carer's Allowance	Child Benefit
Child Tax Credits	Disability Living Allowance Care
Disability Living Allowance Mobility	Employment Support Allowance
Housekeeping / money from people living with you	Incapacity Benefit
Income Support or Jobseeker's Allowance	Maintenance for yourself or a child
Pension Credit	Personal Independence Payment Daily Living
Personal Independence Payment Mobility	Private / Occupational pension
State retirement pension	Statutory Sick / Maternity Pay / Company Sick Pay
Wages / Salary - Net	Working Tax Credits
Other income / benefits	Universal credit