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

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