To get help with Council Tax payment you need to apply for Council Tax Support. The Council recognises that where the Council Tax Support is less than 100% of the Council Tax due there may be cases of exceptional financial hardship where additional support is sought.

Anyone receiving Council Tax Support is likely to experience financial hardship. This scheme exists for those experiencing exceptional financial hardship which is defined as the total weekly amount of uncontrolled outgoings being 65% or more of weekly income. You may draw to our attention any other matter in support of your claim in the space provided on this form.

If your application is successful, the balance on your Council Tax account will be reduced. The maximum amount of help combined with Council Tax Support is 100% of your Council Tax liability. Any hardship payment will be made by way of reduction to your Council Tax Account.

To apply:
  • 1. You must complete an application form (either electronic or paper).
  • 2. You must be registered as a Council Taxpayer in this borough.
  • 3. You must be in receipt of Council Tax Support.
  • 4. You must be experiencing exceptional financial hardship.
We will use the information shown in your Council Tax Support claim. We will need details of your outgoings and confirmation of your current income.

To apply for Council Tax Hardship Payment, please complete the following:

About you

Please note that fields marked * are required.

In order that we can deal with your enquiry quickly and fully, please provide as much information as you can. Failure to provide all of the information requested may result in a delay and we may need to contact you again for more information.

Council Tax account number (8 digits beginning with a 5) *

Title and full name *

Address and postcode *





Daytime telephone number *

Email address

Address to which this claim relates (only if different from the address given above)





Tell us why you need this extra help


Is there anyone who may help you with your Council Tax payments, like other adults who live with you or family/friends? *
Yes  No  

If yes, please give details of how they may help:

Is there likely to be a change in your income, capital or family circumstances compared to that shown in your Council Tax Support claim? *
Yes  No  

If yes, please give details of the likely change - what it is, when it is likely to happen and how it will affect your circumstances:

Please state the steps you have taken to address your exceptional financial hardship. (Please be specific as this could materially affect the outcome of this application). *

How long would you expect to be experiencing exceptional financial hardship? If this period exceeds six months, also please outline why you think this is likely. *

Please confirm any state benefits you receive below (including that of any partner living with you): *
Name of benefit Amount £ How often do you receive it?


Tell us about your uncontrollable outgoings: *
Amount £ How often is this paid? Any debt you owe?
a) Mortgage or Rent (amount not covered by Housing Benefit or DHP)

b) Water Charges

c) Gas/Electricity/other fuel costs (e.g. oil)

d) TV License

e) Travel costs to place of employment

f) Social Fund repayments

g) Court Order fines

h) Loan repayments

Company /person providing loan to you Balance owing £ Repayment offer (if any)
1.

2.

3.


We normally decide claims based upon uncontrollable outgoings and income but you may bring to our attention any other expense or issue that you wish to be considered in the space below.


Declaration

Please read this declaration carefully before signing:
  • -I confirm that as far as I know, the information given on this form is correct and complete.
  • -I give you permission to make any necessary enquiries to check the information on this form with other departments of the Council and other Government agencies
  • -I understand that I will have to pay back any overpayment of Council Tax Hardship payment caused by my failure or delay in telling you about a change in my, or my partner's, circumstances.


What to do now

  • -Make sure you have filled in this form correctly and fully
  • -Include any supporting evidence you have to show you are experiencing exceptional financial hardship
  • -Check you have read and signed the declaration
  • -Complete the Equalities monitoring form (which we use to monitor take-up of this scheme)

Equalities Monitoring

We help people according to their needs. We keep records to show that we treat everyone fairly. Your answers will help us to do this. In each section, please tick the box that best describes you.

Ethnic Origin:

Please tick the box that best describes your ethnic group

Not Stated

White


White Other







Mixed



Black or Black British





Asian or Asian British




Chinese or Other Ethnic Group


Age:

Please tick one of the following



















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