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Do you or your partner receive
Income Support?
Do you or your partner receive Job
Seekers Allowance (income-based)

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Customer Receipt f for Housing Benefit and Council Tax Benefit
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A Application Form - FOR OFFICE USE ONLY

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D Documents Received
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R Receiving Officer Signature
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R Revenue Information Benefits Helpline: 8.30 - 4.30pm - 020 8379 3798

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R Revenue Information Helpdesks: : 9 9.00 - 4.30pm - Civic Centre
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9 9.00 • 4.00pm - John WRkes House
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