COC Sept 15
Reporting a Change
of Circumstances
Benefits, 16 Church Road, Stockton-on-Tees, TS18 1TX
Helpline 01642 393829iMinicom 01642 605569
Housing Benefit and Council Tax Support
If your circumstances change you must tell us straightaway. Use this form to tell us of any changes.
Fill in this form using black ink.
About You
Claim Number
Phone Number
If we need to contact you it may help if you can give us a contact phone number, this can be a mobile number.
About the Change
Date of the change
Details of the change
Please tell us the full details of the change here and provide proof of any changes, such as payslips,
pension slips, rent book. We need to see original documents not photocopies.
I know I must let the council know straight away about any change in my circumstances which might
affect my claim.
I declare the information I have given on this form is correct and complete.