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:

Contact number:

Email address:

Benefit claim reference:

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