Discretionary Housing Payments Underoccupancy Form

Name

Address

Address 2

City/Town

Post Code

Benefit Reference/Claim Number

Contact Telephone Number

Declaration

I confirm that I am currently under occupying my home and wish to apply for Discretionary Housing Payment for this reason

I declare that the information I have given on this form is correct and complete to the best of my knowledge.

I will notify ��Ů�� if there is any change in the occupancy details for my home.

Submitted by

The information you have supplied on this form will be used for the purpose for which you have provided it, and appropriate measures are in place to protect your personal data. A full privacy notice, which provides information about your rights under current data protection legislation and details about what will happen to your personal data can be found here:

Housing Benefit and Council Tax Reduction - Privacy Statement

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