I wish to apply for a discretionary housing payment for the following reason(s).
Who do you currently live with?
Please complete the following questions so we can assess your entitlement to these payments.
Please complete the following questions so we can assess your entitlement to these payments.
When did you move to this address?
If you moved in the past 12 months please state your previous address.
Were you able to afford the rent/Council Tax when you moved in?
- Select - Yes No
If you could not afford the rent why did you take the tenancy on?
If yes, please tell us how you were able to afford it (e.g. in work)?
Have you asked the landlord to reduce the rent?
- Select - Yes No
Have you tried to find cheaper accommodation?
- None - Yes No
Is there a reason why you could not move if you found cheaper accommodation?
Please confirm authorisation for us to contact your landlord directly.
- Select - Yes No
How much notice do you have to give?
When does your current tenancy end?
Do you have relatives or friends who could help?
- None - Yes No
Could relatives or friends provide you with accommodation, if only temporarily?
- None - Yes No
Could relatives or friends, or anyone who lives with you help with the rent or Council Tax?
- None - Yes No
Please confirm the amount of any rent arrears you have.
Please explain what action your landlord has taken against you because of your rent arrears? For example have you received a notice seeking possession and if so when?
Do you or any of your family have any disabilities or health problems?
- None - Yes No
If you have answered "Yes" to the previous question, please provide details.
Have you recently been bereaved?
- None - Yes No
If you have answered "Yes" to the previous question, please provide details.
Do you have rent and/or Council Tax arrears?
- None - Yes No
Do you have any other debts e.g. HP, loans, fines.
- None - Yes No
If you have answered "Yes" to the previous question, please provide details.
Do you have any savings or property (including holiday homes or timeshares) in this country or abroad?
- None - Yes No
Do you have any policies or other long-term investment, which will mature in the future? If so please give details of the policy and maturity date.
Is there anything else that you think we should know in support of your application?
