Fillable Printable Rent Allowance Sample Form
Fillable Printable Rent Allowance Sample Form
Rent Allowance Sample Form
TYPE OF TENANCY
- Sole Tenant of Property/Room?YES NO
If NO - Joint Tenant with whom?.......................................
- Housing Association Tenancy? YES NO If NO PLEASE ANSWER THE FOLLOWING QUESTIONS:
1. Is your Landlord the ex-partner of you or your current partner? YES NO
2. Do you share the accommodation with your landlord? YES NO
3. Are you/your partner the owner or part owner of the above address? YES NO
4. Have you/partner ever been the owner of this property? YES NO
5. Are you or any member of your household related to the landlord or his partner ? YES NO
6. Have you/partner lived at this address before the commencement of this tenancy ? YES NO
7. Do you/partner rent the accommodation from:
(a) Company of which you, your partner, your ex-partner, your partner’s ex-partner,
or a close relative who lives with him is a director ? YES NO
(b) Company of which you, your partner, your ex-partner, your partner’s ex-partner,
or a close relative who lives with him is an employee ? YES NO
(c) A trust of which you, your partner, your ex-partner, your partner’s ex-partner,
or a close relative who lives with you is a trustee or beneficiary ? YES NO
(d) A trust of which your, or your partner’s child is a beneficiary ? YES NO
8. Do you/partner rent your home as a condition of your employment? YES
NO
If you have answered yes to any of the above, please provide full details on a seperate sheet.
Claimant’s name....................................................… Landlord or Agents name .......................................…
Partner’s name...................................................................................................
Address .................................................................… Address .................................................................…
................................................................................… ........................................................................…
Postcode ...............................................................… Postcode..................................................................…
Tel No ......................................................................… Landlord/Agent’s Tel No ............................................
Date moved in ........................................................… Date of Tenancy (if different) ...................................
Previous Address .........................................................................................................................................…
DOES THE RENT INCLUDE PAYMENTS FOR THE FOLLOWING?
Please tick and enter amount if known
Council Tax YES NO £_______ Laundry Facilities YES NO £_______
Water Rates YES NO £_______ Personal Care YES NO £_______
Lighting YES NO £_______ Counselling/Support YES £_______
Hot Water YES NO £_______ Who washes your clothes? Landlord Self £_______
Cooking Fuel YES NO £_______ Who washes your bedlinen?Landlord Self £_______
Heating YES NO £_______ Who cleans your room? Landlord Self £_______
Garage YES NO If YES: Do you have the option to rent the Garage separately ? £_______
How much is your rent? £ Monthly/Fortnightly/Weekly/4 Weekly
Do you have Rent Free Weeks? YES NO If yes how many? ________________
RA1
RENT ALLOWANCE CLAIM
DO NOT DELAY IN RETURNING THIS FORM TO THE HOUSING BENEFIT SECTION
- Ty Elwyn, Llanelli, SA15 3AP 01554 742100
DECLARATION - TO BE COMPLETED BY ALL APPLICANTS
I Declare that the information given is to the best of my knowledge correct and complete and I agree to inform the
Housing Benefit Section as soon as any details change. The Council may make enquiries to check any information. Under
the terms of the Data Protection Act, 1984, information supplied will be treated in confidence but may be used for regis-
tered purposes.
Signed: .....................................................................… Date:......................................................…
DETAILS OF YOUR ACCOMMODATION(Please tick where appropriate)
Flat in part of house Detached House Detached Bungalow Hostel
Flat in a block of flats Semi-Detached House Semi-Detached Bungalow Bedsit
Flat over a shop Terraced House Terraced Bungalow Caravan
Room(s) in a house Maisonette Ground Rent Mobile Home
Is the accommodation furnished YES NO
If YES, is it... Fully Furnished Partly Minimally
Does the accommodation have Central Heating? YES NO
Who is responsible for internal decoration? Landlord Tenant Not Known
IF YOU OCCUPY ONE ROOM ONLY ROOM NO .........................
What heating is there in your room (e.g. Radiator, Fire or None)?.........................................................................
Where is your room in the property? Back Front Side Other
Do you share your room?YES NO
If YES with whom ...................................................................................................................................................
Name of tenant who occupied the room before you...............................................................................................
From 7.4.08 for the majority of new claims and where a change of address has occurred payments must be made to the
tenant. The safest and easiest way is direct into your bank account. Please complete form BACS1 to provide details of
your bank account. If you feel that paying you direct will present a problem, please contact the Housing Benefit Section
immediately.
There will be some circumstances where we will be able to pay the Landlord direct, eg. Housing Association tenants and
where your Landlord provides board as part of the rent. If you fall into this category you can choose to have payments
made to your Landlord. Would you like your rent paid to your Landlord? YES NO If yes please ask your Landlord to
complete form RA2.
Do you have a tenancy agreement? YES NO . If yes please send us this document. If No please ask your Landlord to
complete form RA2.
Please state period of notice necessary to end tenancy (if applicable).................................................................
How many floors are there in the property? ..........................................................................................................
Which floor do you live on? All Basement Ground 1st 2nd 3rd
DO NOT TICK
Living
Rooms
Bedrooms
Bed-sitting
Rooms
Kitchen Bathroom
Separate
Toilet
Other
Total
Rooms
Total rooms in property
No. of rooms used only by tenant
No. of rooms shared
Who prepares the meals?
Name Age Full Board Half Board Breakfast Only
Landlord or
Agent
Self
1
2
Does your Landlord provide you with any meals as part of the rental agreement? YES NO
If YES please complete the following:
IF YOU DELIBERATELY GIVE FALSE INFORMATION YOU MAY BE PROSECUTED
PCU3441
