Benefits - Report of Change In Circumstances

Please use this form to report any changes in your/your household’s circumstances that you think might affect your Council Tax and/or Housing Benefit, Council Tax Benefit, Second Adult Rebate. If you are unsure whether you need to tell us, we recommend that you tell us anyway and we will let you know the outcome. If we require further information we will contact you in writing or by telephone.

For the purposes of this form, Benefit is defined as Housing Benefit, Council Tax Benefit and Second Adult Rebate

Help and Advice: For help and advice with the completion of this form, please contact the Council’s Operations Team by telephoning Freephone 0800 393811.

Please fill out any relevant fields below, fields in RED are mandatory.

Your Name

Current Address

Telephone/Mobile Number

Date of Birth *

Benefits Claim Number

Council Tax Reference

National Insurance Number

There is a new member of my householdName of new occupant

Date new occupant arriveddd/mm/yy

Previous Address of new occupant

There is a second new member of my householdName of second new occupant

Date second new occupant arriveddd/mm/yy

Previous Address of second new occupant

There is a third new member of my householdName of third new occupant

Date third new occupant arriveddd/mm/yy

Previous Address of third new occupant

A member of my household has moved outName of previous occupant

Date occupant leftdd/mm/yy

Forwarding Address of previous occupant

A second member of my household has moved outName of second previous occupant

Date second occupant leftdd/mm/yy

Forwarding Address of second previous occupant

A third member of my household has moved outName of third previous occupant

Date third occupant leftdd/mm/yy

Forwarding Address of third previous occupant

Member(s) of my household have turned 18 yearsPlease list Name(s) / Date of change

I wish to report a change to an occupants income, capital or other finances

Detail of above change

Started Work Stopped Work Benefit has changed Working more hours Working less hours Changed jobs Capital has changed Rent has changed Childcare costs have changed

I wish to report a change to a second occupants income, capital or other finances

Detail of above change

Started Work Stopped Work Benefit has changed Working more hours Working less hours Changed jobs Capital has changed Rent has changed Childcare costs have changed

I wish to report a change to a third occupants income, capital or other finances

Detail of above change

Started Work Stopped Work Benefit has changed Working more hours Working less hours Changed jobs Capital has changed Rent has changed Childcare costs have changed

I would like to withdraw my Benefit claim because:

Any Other Changes?

Please complete this section if you would like the Finance
Service to share the information you have provided on this
form with other Council Services. This will enable the
Services you select to update their records. The selected
Service may have to cont

Education Culture and Sport Planning and Development Housing and Property Chief Executive's Office Social Work Transport, Environment and Community Service

I declare that the information I have given on this form is
correct and complete. I authorise the Council to check the
information I have given and make any necessary enquiries to
verify the information on this form. I will immediately
submit a further fo *

I agree

The information on this form is required to enable a response to be made to any comments or complaints provided. The information will be held by the Highland Council under the terms of the Data Protection Act 1998 and will not be used for purposes unrelated to those for which the information was gathered.