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Part 15 - Declaration

Declaration
Please read this declaration carefully. You must sign it if you can, even if someone else has
answered the questions for you.
If you have a partner, they should sign the declaration as well. Getting them to sign this form

should allow us to process your claim more quickly, but they do not have to sign.
• I understand that this claim is made to you, my local council
• I declare that the information I have given is correct and complete
• I understand that if I knowingly give information that is incorrect or incomplete, I may be
liable to prosecution or other action.
• I understand that the council is in receipt of information from other government agencies e.g.
HMRC who pass on all information regarding interest paid on all bank/building society
accounts. We may also get information about you from certain third parties or give them
information to prevent or detect crime, protect public funds and make sure the information is

correct.
• I agree that the Council will use the information to process my claim for Housing Benefit or
Council Tax Support. It can make enquiries to check the information I have given - including
checking with other sources in the Council, the Pension Service, Jobcentre Plus, the Inland
Revenue, the Rent Service and other Councils.
• I understand the Council may use any information I have provided in connection with this
and any other claim for benefits I have made or may make. It may give some information to
other government organisations, within the law.
• I will let the Council know straight away about any changes in my circumstances which might

affect my claim. I have read the section 'Changes you must report’ which explains this.

Your partner’s signature:

Declaration
If someone has completed the form on your behalf, such as an agent, appointee, relative or friend, please
complete the section below:
1) Name of the Person who completed the form:

2) I have read and understood the declaration. I declare that the information I have given on
this form is correct and complete

Signature of person:

Relationship to the claimant, eg friend, landlord, relative:

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