Self-Employed Income Review
Your details
Benefit claim reference number
Your reference number must contain 8 digits
Full name
Address (including postcode)
Contact number
Email address
Business details
Name of business
Type of business
Date business started
Are you a director of the business
Yes
No
Is your business a partnership?
Yes
No
Please list the partners and their percentage share of the business
Names and % share
Accounts
Please give the exact period covered by the following accounts.
From
To
Please enter a value in each field below:
Income/Sales
Plus enterprise allowance
Plus closing stock
Less purchases
Less opening stock
Total calculated gross profit
Average weekly hours worked
Expenses
Please list below all expenses (amounts that relate only to the business)
Accountancy
Bank charges
Advertising
Business insurance
Business rates
Drawings
Employees' wages (not you or your partner)
Heating and lighting for business
Interest payments (for business loans only)
Petrol for business use (or other fuel)
Postage
Protective clothing or uniforms
Rent/mortgage for business premises
Repairs for business
Road tax for business use
Stationery and printing
Telephone for business use
Vehicle insurance for business use
Wages paid to your spouse
Wages paid to yourself
Other business expenses
If you have entered a value for 'Other business expenses', please provide details
Total calculated
Business directors
Gross pay
How much do you get paid before tax, national insurance and any pensions?
Frequency
Please select...
Week
Fortnight
Four Weeks
Month
Tax
How much tax is deducted?
Frequency
Please select...
Week
Fortnight
Four Weeks
Month
National insurance
How much national insurance is deducted?
Frequency
Please select...
Week
Fortnight
Four Weeks
Month
Pension
How much pension is deducted?
Frequency
Please select...
Week
Fortnight
Four Weeks
Month
Warning
It is an offence for anyone to make a statement or produce information that they know to be false, in order to obtain Housing Benefit or Council Tax Reduction. A person, if convicted, can be fined, sent to prison or both. You must tell us within 21 days of the date any change occurs that could affect your Council Tax. Failure to do so may result in a penalty of £70.00 which is payable in addition to any increased charge. You must tell us within one month of the date any change occurs that could affect your Housing Benefit. Failure to do so may result in an overpayment which may be recoverable from you.
Declaration
I have filled in this form and declare that the information given within it is true and complete to the best of my knowledge. I will immediately tell the Council's Revenue and Benefits Service within 21 days, if my circumstances change
I have read and understood the information above.
Full name
Date
We will use the information you give in this form and any supporting evidence you send us to determine the end date for your Housing Benefit and/or Council Tax Reduction and your Council Tax Liability. We may pass the information to other agencies or organisations such as the Department for Work and Pensions, the Jobcentre Plus and HM Revenue and Customs, as allowed by the law. By law, we may check the information you have provided, or information provided about you by someone else, against other information we already have. We may also ask other agencies, organisations, local authorities or government departments to give us information they have about you. This is to make sure the information is accurate, prevent or detect crime and protect public funds. This includes government departments, local authorities and private-sector companies such as banks and organisation that may lend you money. We will not give information about you to anyone else, or use information about you for other purposes unless the law allows us to. Folkestone & Hythe District Council is the data controller for the purposes of the Data Protection Act 1998. If you want to know more about what information we have about you, or the way we use the information, you can ask.