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Part 3 - Anyone else who lives with you (continued)

Person 4

Surname First names Date of birth Relationship to you

Do they get Income Support,
Jobseeker’s Allowance, Do they work 16 What is their gross
National Insurance number Employment and Support hours or more a income? (see note
Allowance or Pensions week? below) £
Credits?

Yes [ ] No [ ] Applied for
Yes [ ] No [ ]
(date): ...................................

Do any of the people living with you live as a couple? If
Yes, please state who is the partner of whom:

Have any of the above persons an additional income? If
Yes state name(s) and give details

Boarders and sub-tenants
Do you rent out part of your home to someone?
Please give their names

How much do you charge them each week?

Does this charge include their heating? Does

this charge include any meals?

HB/CT8 07 04/2013 7
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