Council Tax income and expenditure 
                         
                     
                 
                
                    
                        
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            First and middle name(s) Required  
        
        
     
    
    
        
            Do you have a partner?: Required  
        
        
     
    
        
            Partner's first and middle name(s)  Required  
        
        
     
    
        
            Partner's surname  Required  
        
        
     
    
        
            Council Tax account reference number Required  
        
        
     
    
        
            My address 
            Please enter your postcode and then click "Find address" to look up your address.
         
     
    
	
        
		
            
                
                    Enter postcode: 
                
                
                    
                    
                    Please enter your postcode 
 
                
             
            
        
	 
        
        
            
            
            
                Even though you cannot see the address, you still need to put one in. If you know your postcode then input it and click 'Find address'. If you dont know your postcode then click on 'Enter manually'. 
 
         
    
 
        
            Your National Insurance number 
        
        
     
    
        
            Your partner's National Insurance number 
        
        
     
    
    
    
        
            
Employment details 
            My employment details 
        
     
    
        
            Do you have a paid job? Required  
        
        
     
    
        
            
                Employer's company name Required  
            
            
         
        
            
	
        
		
            
                
                    Enter postcode: 
                
                
                    
                    
                    Please enter your postcode 
 
                
             
            
        
	 
        
        
            
            
            
                Even though you cannot see the address, you still need to put one in. If you know your postcode then input it and click 'Find address'. If you dont know your postcode then click on 'Enter manually'. 
 
         
    
 
            
                Expected net pay per month Required  
            
            
         
        
     
    
        
            
My partner's employment details 
        
     
    
    
        
            
                Employer's company name Required  
            
            
         
        
            
                
Partner's employer's address 
            
         
            
	
        
		
            
                
                    Enter postcode: 
                
                
                    
                    
                    Please enter your postcode 
 
                
             
            
        
	 
        
        
            
            
            
                Even though you cannot see the address, you still need to put one in. If you know your postcode then input it and click 'Find address'. If you dont know your postcode then click on 'Enter manually'. 
 
         
    
 
            
                Expected net pay per month Required  
            
            
         
        
     
    
        
            What benefits does the household receive? Select the benefit, enter a name, the amount and the frequency:   
        
     
    
    
    
    
        
             
        
        
            Select benefit: 
        
        
            
	- select a benefit - 
	Council Tax support 
	Housing Benefit 
	Income Related Job Seekers Allowance 
	Income Support 
	Guaranteed Pension Credit (not just state retirement pension) 
	Employment and Support Allowance 
	Universal Credit 
	NHS Tax Credit Exemption Certificate 
	Assistance with NHS Charges (HC2 or HC3 Certificate) 
	16 – 19 Discretionary Grant 
 
        
     
    
    
    
        
             
        
        
            How often is it received? 
        
        
            
                
	- select a frequency - 
	Weekly 
	Fortnightly 
	Monthly 
	Bi-Monthly 
	Quarterly 
	Annually 
 
            
         
     
    
    
    
        
            
Household expenses - amount spent per month 
        
     
    
        
            Rent or mortgage Required  
        
        
            
            Please enter a value. Enter 0 if you do not have these expenses 
Please enter a number 
 
     
    
        
            Council tax Required  
        
        
            
            Please enter a value. Enter 0 if you do not have these expenses 
Please enter a number 
 
     
    
        
            Electricity Required  
        
        
            
            Please enter a value. Enter 0 if you do not have these expenses 
Please enter a number 
 
     
    
        
            Gas and water rates Required  
        
        
            
            Please enter a value. Enter 0 if you do not have these expenses 
Please enter a number 
 
     
    
        
            Housekeeping, food and drink Required  
        
        
            
            Please enter a value. Enter 0 if you do not have these expenses 
Please enter a number 
 
     
    
        
            Loans and credit card payments Required  
        
        
            
            Please enter a value. Enter 0 if you do not have these expenses 
Please enter a number 
 
     
    
        
            Child care costs Required  
        
        
            
            Please enter a value. Enter 0 if you do not have these expenses 
Please enter a number 
 
     
    
        
            TV licence/rental/entertainment packages Required  
        
        
            
            Please enter a value. Enter 0 if you do not have these expenses 
Please enter a number 
 
     
    
        
            Phone bills (landline and mobile) Required  
        
        
            
            Please enter a value. Enter 0 if you do not have these expenses 
Please enter a number 
 
     
    
        
            Travel Required  
        
        
            
            Please enter a value. Enter 0 if you do not have these expenses 
Please enter a number 
 
     
    
        
            Other Required  
        
        
            
            Please enter a value. Enter 0 if you do not have other expenses 
Please enter a number 
 
     
    
        
            Is there any other information you want to tell us? 
        
     
    
    
    
        
            Please accept the terms and conditions 
Please enter a payment amount 
Please select payment frequency 
Please enter a payment start date 
 
     
    
        
            Signed: Required  
        
        
        
            Dated: Required  
        
        
     
    
    
    
        
            Please complete the validation below: