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Please provide your last 3 months statements for all bank/building society accounts held as evidence of your outgoings.
Tell us about your weekly income within the household and the way you spend it.
Based on your budget, what is the most you can afford to pay towards your rent?
Based on your budget, what is the most you can afford to pay towards your Council Tax bill?
Tell about any disabilities, health problems, special needs etc. for you or your family. Has your property
been adapted to assist with any disability? If you receive DLA or PIP how do you spend this money?
(continue on a separate sheet of paper if necessary).
If you own your property and are applying for help with your Council Tax only go straight to Question 6. Declaration
Tell us if you have tried to re-negotiate the rent with your landlord, you have looked for cheaper
accommodation or signed up with Devon Home Choice. Is there a particular reason why you cannot
move, were you aware that your rent would not be met in full when you accepted the tenancy and if
so, how you had planned to meet it. Have you sought any debt advise and if so where from?
Please check that you have completed the form accurately and then read and sign
the following declaration.
I understand all of the following:
I know that I must let the Benefits Team know about any changes in my circumstances
that may affect my claim.
I declare that the information I have given on this form is correct and complete.
I give permission to pass on my details to third party agencies for assistance with debt and money advice.
Please tick to confirm if you agree with the above statement: Check Declaration2
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