Discretionary Housing Payment & Council

Tax Discretionary Relief Application Form

Title Ms
First name shenaz
Surname tayoub
Mobile number 07926994475
Email address shenaz81@hotmail.com
House 34
Street Asha Margh
Town Leicester
County Leicester City
Postcode LE4 5LE
Housing benefit or universal credit reference number: 2027154355
Council tax reference number: 2027154355
National insurance number: JS580629B
I want to claim extra help with my housing and council tax costs. I want this form to
be treated as either a claim for discretionary housing payment or council tax
My rent and council tax
discretionary Relief; and an intention to claim housing benefit or local council tax
reduction:
I want to claim help from (please insert the date you would like your extra help to
27/03/2024
start from):
Housing association
I am a:
tenant
If you are a Private, Council or Housing Association tenant has your Housing Benefit
No
been reduced because you have too many bedrooms?
In most circumstances you will be required to register on the Housing Register if your Housing Benefit has been
reduced because you have too many bedrooms, however there maybe circumstances which prevents you being
on the Housing Register. Please explain below what these reasons are.

You can apply online: https://www.leicester.gov.uk/your-community/housing/apply-for-housing/who-can-apply/

My benifits are capped
I wish to apply for the following reasons: and i am struggling to pay
the rent and council tax
Do you have council tax arrears? No
Are you paying mortgage or rent? Rent
Do you have any rent arrears? Yes
How much arrears are you in? £600
Please provide proof of your arrears
Have you asked your landlord to accept less rent? No
Please ask your landlord to accept less rent, if they accept your request, please let us know
Has your landlord served a Notice of Seeking Possession Order? (Please provide
No
proof)
Do you have any other debts (loans, credit cards etc)? No
Did you move into this property in the last 12 months No
Is anyone in your household unable to share a bedroom due to a medical need? No
Is anyone who normally lives in your household a member of the armed forces? No
Are you a registered foster carer who needs additional bedrooms? No
Has your property been adapted for any disability needs? No
Does anyone in your household need a regular overnight carer who does not live
No
with you?
Have you asked your landlord if you can downsize from your current
No
accommodation?
If yes, please give details. If no, please explain why: i am living with my 5 kids
my dam and mum both
If you have exceptional reasons for why you cannot move, please provide as much passed away last year
information here and i am living with my 5
kids
Would you like to enter your spending as weekly or monthly? Monthly
Household and living cost

Rent: £534.00
Payments being made to rent arrears: £150.00
Mortgage or mortgage protection payments: £0.00
Council tax payments: £61.00
Arrears of council tax payments: £0.00
Food bills: £399.00
Household goods (furniture): £20.00
Fuel (electricity, gas, other fuels): £300.00
Payment towards arrears of fuel bills: £50.00
Water rates: £29.00
Telephone/internet: £70.00
Mobile only: £39.00
TV Licence/Rental: £15.00
Clothing: £70.00
Family and friends

School meals: £30.00

Childcare: £0.00
Child maintenance: £-1.00
Insurance and finance

Home/contents insurance: £15.00

Endowment/life insurance: £0.00
Loans/fines/hire purchase: £0.00
Credit card payments: £0.00
Personal goods and services including health: £0.00
DWP deductions for past loans: £0.00
Any other deductions from benefit: £0.00
Disability spending: £0.00
Travel and leisure

Travel: £100.00
Road tax/car insurance: £0.00
Petrol/oil: £0.00
Car servicing: £0.00
Alcohol/cigarettes/tobacco: £0.00
Total spending: £1881.00
Would you like to enter your income as weekly or monthly? Monthly
Employment

Net wages (self): £0.00

Net wages (partner): £0.00
Self-employed earnings: £0.00
Benefit / allowance / credit

Universal credit: £1456.63

Income support: £0.00
Jobseekers allowance: £0.00
Employment support allowance: £0.00
Maintenance received: £0.00
Working tax credit: £0.00
Disability living allowance: £0.00
Personal independence payment: £0.00
Attendance allowance: £0.00
Incapacity benefit: £0.00
Family / friends

Child benefit: £286.00

Child tax credit: £0.00
Contributions from children at home: £0.00
Contributions from other residents: £0.00
Pension

State pension: £0.00

Private pension: £0.00
Pension guarantee credit: £0.00
Pension savings credit: £0.00
Total income: £1742.63
Savings

Bank accounts: £0
Building society: £0
ISAs: £0
Shares: £0
Premium bonds: £0
Value of other properties owned: £0
Total Savings: £0
I am: The claimant
I understand the following:

You will use the information provided to consider my claim for housing benefit, discretionary housing payments,
council tax support or council tax discretionary relief – or any or all of the above. You may cross check the
information with other sources within the council or other councils. Data held may be used in comparison for the
purposes of the prevention and detection of crime.

You may use any information I have provided in connection with this and any other claim for social security
benefits that I have made or may make. You may share information with other government organisations, if the
law allows this. I know that I must let Leicester City Council know straightaway about any change in my
circumstances that might affect my claim. I understand that if I knowingly provide false or incomplete
information, or fail to inform you of changes in my circumstances, I may be prosecuted.
I declare that the
information I have given
I declare that the information I have given on this form is correct and complete.
on this form is correct and
complete.
Equalities monitoring

In order to meet your needs and improve the services we offer, we need to know a bit more about you. Please
help us by completing this form which describes how you see yourself. This information is confidential and is for
our monitoring use only.
Any other Asian
Ethnic background:
background
Gender Female
Date of birth: 11/12/1981
Age in years: 42
Do you consider yourself to have a disability, or a long-term illness, physical or
Prefer not to say
mental health condition?
Sexual orientation: Heterosexual/straight
Religion or belief: Muslim
Thank you for completing this monitoring form. The information you have provided will be kept in accordance
with the terms of the Data Protection Act 1998 and will only be used for the purpose of monitoring. Your details
will not be passed on to any other individual, organisation or group. Leicester City Council is the data controller
for the information on this form for the purposes of the Data Protection Act.