Self Employed Earnings Form by o64e0bx

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									HOUSING BENEFIT AND COUNCIL TAX BENEFIT
SELF EMPLOYED EARNINGS DECLARATION

Ref No:                               BSEIFORM



Please complete all sections as failure to do so may result in a delay in processing your
claim. Where you are given an option of Yes or No – please delete as appropriate.

If you are the director of a limited company you are not self employed. You do
not need to complete this form. Please provide evidence of any income and
dividends you receive from the company.

EVIDENCE IS REQUIRED WHERE INDICATED

SECTION 1 – ABOUT YOURSELF

Surname              …………………………………………..........................................
Other names          ………………………………………..............................................
Address              .…………………………………………………………………….

SECTION 2 – ABOUT YOUR BUSINESS

Name of business           ........................................................................................
Address of business        …....................................................................................
Type of business           .........................................................................................

Date business commenced                                                                   ..............................
Start date of current financial year                                                      ..............................
Average hours worked per week                                                             ..............................

If you are a partner in the business, state your %                                        ..............................
Name(s) of other partner(s)                                                               ..............................
Relationship to you, if any                                                               ..............................

Are there any other people on the payroll of the business? .……..……………..
Do you use part of your own home for business purposes?    ...…………………..
If yes, give details …………………………………………………………………………….

SECTION 3 – MISCELLANEOUS DETAILS

Do you have a business start up allowance?                 Yes / No
(Please provide proof)

Please give the start date and weekly amount                                   ..................      .................


Do you have prepared accounts for the last financial year which include a profit and
loss sheet, trading account and balance sheet?                  Yes / No

If yes, please return a copy with this form and go straight to SECTION 6


                                                   1
If no, please give reasons why and the date you expect to have them.
......................................................................................................................................

SECTION 4 – INCOME

State exact period covered                                      From ………………                        To ……………………
This should be your last financial year OR, if you have not been trading for a year, it should be the
date your business started up to the current date. In no circumstances should the period be more than
12 months.

Sales / Takings / Income / Fares                                                                            ..........................
PLUS      Vat refunded                                                                                      ..........................
PLUS     Start up allowance                                                                                 ..........................
                                                                                                   Total..........................

LESS      Cost of sales
          Opening Stock ………………..
        + Purchases             ……………….
        - Closing Stock          ………………..
       = Cost of Sales                                                                                    ...........................
LESS      Vat paid out                                                                                     ...........................


Gross Profit or Fares received (taxi/ private hire)                                                        …………………..

SECTION 5 – EXPENSES

You should only include amounts that relate solely to the business, for the same
period stated in SECTION 4.

YOU MAY BE REQUIRED TO PROVIDE PROOF OF ANY EXPENSES LISTED.

WAGES PAID OUT                            TO      SELF                                                       ..………………..
                                          TO      SPOUSE/PARTNER                                            ..........................
                                          TO      OTHERS                                                    ..........................

RENT (Business Premises or proportion of your home rent attributed to business)..........................

BUSINESS RATES                                                                                              ..........................

HEATING AND LIGHTING                                                                                        .………………...

WATER                                                                                                       .………………...

CLEANING                                                                                                    .…………………

TELEPHONE
Mobile                                                                                                      ..........................
Landline                                                                                                    ..........................
BUSINESS INSURANCE                                                                       ..........................

ADVERTISING, PRINTING, STATIONERY & POSTAGE                                              ..........................

BANK CHARGES                                                                             ..........................

INTEREST PAYMENTS ON BUSINESS LOANS                                                      ..........................

CAPITAL PAYMENTS ON BUSINESS LOANS                                                       ………………….

PLEASE STATE THE PURPOSE OF THE LOAN………………………………………..
(Please enclose a copy of loan agreement)

REPAIR OF A BUSINESS ASSET                                                                ………................
Was this covered by insurance?                                                YES                    NO

LEASING CHARGES                                                                          ..........................

BUSINESS ENTERTAINMENT                                                                   ..........................

PROFESSIONAL SUBSCRIPTIONS                                                               ………………….

DRAWINGS                                                                                 ………………….

DEPRECIATION                                                                             ………………….

BAD DEBTS                Please specify      ......................................................................

OTHER EXPENSES Type / Amount                 ..............................              ..........................

                         Type / Amount       ..............................              ..........................

                         Type / Amount       ..............................              ..........................

                         Type / Amount       ..............................              ..........................

                         Type / Amount       ..............................              ..........................

MOTORING EXPENSES (please state if the amount paid is for a full year or less)
Petrol/Diesel (state which)                                          ..........................
Repairs                                                              ..........................
Road Tax                                                             ..........................
Car Lease                                                            ..........................
Insurance                                                            ..........................
Licence Fees / Badge (Taxi Drivers)                                  ..........................


Who owns the Vehicle?                 Business / Self


If business, do you use the vehicle for domestic or other purposes?                           Yes / No
Is it reasonable to assume that the trading figures for the next 12 months will be
similar to those given above?    Yes / No                     
If No, please explain the likely differences.




SECTION 6 – OTHER OUTGOINGS

PERSONAL PENSION CONTRIBUTIONS                  Amount                ..........................
(Proof is required)                             Frequency             ..........................



SECTION 7 – DECLARATION

Please read this declaration carefully before you sign and date it.

I declare that the information I have given on this form is true and complete. This
information together with the information on my claim form correctly represents my
circumstances as they are at the present time.

I know I must let the council know about any changes in my circumstances.

I understand that if I give information that is incorrect or incomplete, you may take
action against me. This may include court action.

I agree that you will use the information I have provided in connection with my claim
for Housing and/or Council Tax benefit. You may check some of the information
with other sources as allowed by law.

I understand that you may use any information I have provided in connection with
my claim for housing benefit and/or council tax benefit with any other claim for social
security benefits that I have made or may make. You may give some information to
other organisations, as allowed by law.

SIGNATURE ………………………………………
DATE ……………….

								
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