Request claim form for housing benefit

Title *

First name and middle name *

Surname *

Date of birth *

Your address *

Postcode *

Daytime telephone number. We will use this number to contact you about your claim *

Email address - Providing your email address will speed up the processing of your claim.

Preferred method of contact *

What do you intend to claim for? *

Benefits calculator claim reference number *

Benefits calculator estimate £ *

Personal data is processed in accordance with the Council’s Privacy Notice. Please see Sections 1 to 10 and section 11 for details.

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