1 Current Page 1 2 Page 2 3 Page 3 4 Page 4 5 Page 5 6 Page 6 7 Page 7 Housing Benefit account number Your details Name Customer name Title Title - Select -MissMsMrMrsDrOther… Enter other… First Last Address Customer address Address Address 2 City/Town Post Code Contact Telephone number Email address Additional details Date of Birth National Insurance Number Your Benefits Which of the following benefits do you receive? Housing Benefit Universal Credit Housing Costs - What do you need help with? I need help with: My rent Yes No Rent in advance for a new home Yes No A rent deposit for a new home Yes No Removal costs to help me move to a new home Yes No Other Yes No Please tell us here: Status message Please ensure you have filled in all fields to continue 15471
