Change in circumstances

This form is for you to use if you have a change in circumstance whilst your claim is in payment.

Note: Those questions marked with an * must be completed.

Benefits claim ref. no. (if known)

Name

Title
If Other, please specify
First name(s) *
Surname *

Date of birth *

Date of birth

Address

If the address is within North Lincolnshire, enter the post code in the box below and then select "Find Address". If the address is outside of North Lincolnshire, or your address is NOT SHOWN in the list or is incorrect, you will need to enter the the address in the boxes provided below.

Post Code *


Prefix e.g. first floor flat.
House Number/Name *
Street *
Town/Village
County
Country

Daytime tel. no.

Email address

Note: on submitting your completed form, if you have provided a valid email address above you will automatically receive a copy of your completed form.

Date your circumstances changed *

Date your circumstances changed

Who does the change affect? (Please provide the name and date of birth of all the person(s) affected by the change) *

What is the change? (You will need to provide documentary evidence of this) *

I agree to provide documentary evidence of this change within the next 7 days. More information on the type of evidence you need to provide can be found in the Housing and Council Tax Benefit claim form.

Please tick the box to agree to the above statement *

I agree

The information on this form is true and complete. This information, together with the information on my claim form, correctly represents my circumstances as they are at the present time. I will report any other changes in my circumstances to the council.

Please tick the box to agree to the above statements *

I agree

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