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CHANGE OF ADDRESS

Both you, your Landlord or Agent will also need to complete Part 5.

Part 4:

Declaration:

Has your income or capital changed in any way si made a claim?

If Yes, please give details and provide original documents as proof.

• I declare that the information given on this form is correct and complete
• I understand that if I give information that is incorrect or incomplete, you may take
action against me. This may include court action.
• I agree that you will use the information I have provided to process my claim for
Housing Benefit or Council Tax Benefit or both. You may check some of the
information with other sources as allowed by law.
• I understand that you may use any information I have provided in connection with
this and any other claim for social security benefits that I have made or may make.
You may give some information to other organisations, such as government
departments, local authorities and companies such as banks and organisations that
may lend me money if the law allows this.
• I know that I must let you know in writing straight away about any change in my
circumstances that might affect my claim.

Signature of the person claiming:

Date:

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