Con
ti
nued
If you
need
more room, pl
ease
continue
on
another
sheet
of
paper
and
attach.
Declaration
CLAIMANT: I declare that to the best
of
my knowledge
the
information given
Is
true and complete.
Signature
Date
PARTNER:
I
am
the
partner shown
on
the
form. I confirm that
the
information given about
me
is
correct.
Signature Date
The
personal Information
you
provide
will
be
proassec~
n
acalrdana
wfth
the
Data Protection Act 1998.
Please
return this completed form and any evidence
of
your change In circumstances to:
Housing
Benefit
and
Council Tax
Support
North
Devon Council,
PO
Box 379,
lhimstaple
EX32
2GR
~
'
'
Contact
information
Please post
the
completed
form
back
to
us at:
Housing
Benefit
and
Coundl
Tax
Support
North
Devon Council,
PO
Box
379
Bamstaple
EX32
2GR
Or
you
can
drop
it
in
to
one
of
our
offices:
Lynton House, Commercial Road, Barn staple
The llfracombe Centre,44 High Street
Amory
Centre, 125
East
Street, South
Molton
If
you
have any questions,
or
you
need
help
filling
in
the
form, please
get
In touch:
Telephone 01 271
388877
benefits@northdevon.gov.uk
www.northdevon.gov.uk/benefits
If
you
require this
informat
i
on
In an alternative
format, please contact us.
Housing Benefit & Council
Tax
Support
North Devon
Council,
PO
Box
379
Bamstaple
002
2GR
COUNCIL
Tell
us
if
your
circumstances
change,
as
it
may
affect
your
benefits.
www
.. "1011hdevon.gov.uk
click to sign
signature
click to edit
click to sign
signature
click to edit
Please
tell
us
if
your
circumstances
change
The
amount
of
Housing
Benefit
and
Council Tax
Support
you receive depends
on
many different
things. Please make sure
you
tell us
if
something
in
your
life changes. A change could mean
that
your
benefits
go
up
or
down.
If
you
don't
tell us
about
changes in
your
circumstances,
it
could mean
that
you
are
overpaid and you will have
to
pay
it
back.
If
you
are entitled
to
more benefits
as
the
result
of
a
change, you must tell
us
within
one calendar
month,
or
you
might
lose
out
on
some benefits.
Check
the
list opposite
for
examples
of
changes
that
could affect
your
benefits.
If
your
change
isn't listed, please complete and return
the
form
to
us anyway. We will
let
you
know
if
your
benefits are
going
to
change.
Fill
in
the
form
attached
to
this
leaflet
and
return
it
to
us
as
soon
as
possible,
along
with
any
evidence
of
your
change.
Income
an increase
or
decrease in pension
an increase
or
decrease in any other state
benefits
an increase
or
decrease in earnings
an increase
or
decrease
to
the
amount
of
savings you have
if
you stop receiving any
other
benefits
or
allowances such
as
Jobseekers Allowance
or
Income Support
if
you start receiving any
other
benefits
or
allowances
an increase
or
decrease in
the
tax credits you
receive.
Accommodation
details
if
you change
your
accommodation
ifyourrentalters
if
you start
to
share
with
someone.
Household
details
if
your
children leave school, college
or
university
if
you
or
your
partner are away from
home
for
more
than
4 weeks
if
you have an addition
to
your
family
if
someone leaves
your
household
if
there are any changes
to
your
childcare
costs.
Housing
Benefit
and
Council
Tax
Support
Change
in
circumstances
form
Name
Address
Postcode
Daytime telephone
Mobile
Claim
reference
Date
of
the
change
Please
give details
of
your change in
circumstances
Continue
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