Discretionary Housing Payment Application Form

Data Protection Privacy Notice

Please read this Privacy Notice which explains how any personal information you provide on this form will be used by Rushcliffe Borough Council.

Full name:

Address:

Enter postcode...

Contact number:

Email address:

Benefit claim reference:

This is a number beginning with an 8 and is 9 digits long.

National Insurance number:

Please enter without spaces.

If someone is assisting you with this application, please provide their contact details below (name, organisation they represent, mobile phone number and email address).

Name:

Name of organisation:

Contact number:

Email address:

Sections

Your Details
Information
About Your Current Address
Income
Outgoings - Utilities
Outgoings - Other Expenses
Bank Account and Capital Details
Declaration
Documentation