Housing BenefitCouncil Tax Benefit - Business Income and Expenditure

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                                            Arun Revenues & Benefits Services    Tel: 01903 737753
                                            Arun District Council                Fax: 01903 725594
                                            Arun Civic Centre                    DX:57406 Littlehampton
                                            Maltravers Road                      Minicom: 01903 732765
                                            Littlehampton                        email:revenues.benefits@arun.gov.uk
                                            West Sussex, BN17 5LF                website: www.arun.gov.uk/benefits




     Housing Benefit/Council Tax Benefit – Business Income and Expenditure Form


Name                                                  Claim
                                                      number

Home address                                          Business
                                                      address

Telephone number



                                       About your business
What is the name of your business?

What is the nature of your
business?

When did you start trading?

Have you registered the business with the HMRC?                     Yes           No

NB. If you have registered your business, please provide evidence of this such as a letter from
HMRC. If you have not registered, we will expect you to have done so within 3 months and will
request evidence of this.

Is your business a partnership?             Yes            No

If yes, what percentage of the total profit/loss is                    %
yours?

Is your spouse a partner in the business?              Yes             No

If yes, what percentage of the total profit/loss is                         %
his/hers?

Are there any other people on the payroll of the business?


Do you make any contributions to a personal pension                             Yes         No
scheme?

If yes, how much do you pay?      £                   Every
                                   Business Income and Expenditure

  Please give details of your business income and expenditure for your current trading year or since your
                      business commenced (if you have not been trading for one year).

Period of details supplied      from                     To


Number of weeks covered                    How many hours do you work each
                                           week?


                                            Business Income
Please state the income of your business during the period stated above.

Sales and work done        £                           Commission, interest etc.   £
(before drawings)

Other (please specify)     £                           Other (please specify)      £



                                          Business Expenditure

              Please list below the expenditure of your business during the period stated above.

Please do not include depreciation, business entertainment, HP, money spent to set up or expand the
business or any loss made before you made your claim.

Expense                                            Total                   % of total
                                                   expenditure             expenditure
                                                                           private use
Purchase of goods for resale                       £                       %
Gross wages paid to employees                      £                       %
Rent/mortgage interest (business premises)         £                       %
Business/water rates                               £                       %
Heating and lighting (business only)               £                       %
Insurance (excluding vehicle insurance)            £                       %
Postage                                            £                       %
Telephone                                          £                       %
Printing and stationery                            £                       %
Advertising                                        £                       %
Repairs and maintenance                            £                       %
Motor expenses:     Fuel                           £                       %
        “           Road tax                       £                       %
        “           Insurance                      £                       %
        “           Repairs and renewal            £                       %
Other expenses (please specify)                    £                       %
                                                   £                       %
                                                   £                       %
                                                   £                       %



 Please be aware you may be asked to provide evidence of the income and/or expenditure declared in this
                                                 form.
                                              Declaration
I declare the information I have given on this form is correct and complete. I know I must let the
council know about any changes in my circumstances which may affect my claim. Even if
someone else has filled in this form for you, you must sign the declaration if you can.

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

I understand that you make take criminal proceedings against me if:
• I lie to you so that I can get benefit;
• I give you false documents so that I can get benefit;
• I do not tell you about any changes to my circumstances that may affect my claim; or
• I claim benefit when I know I should not.

I will contact you and tell you about any changes to:
• my income, my partner's income and the income of anyone else who lives with me;
• my savings and my partner's savings;
• the number of people who live with me;
• my address and my rent; and
• my marital or civil partnership status; and
• any other change to my circumstances or the circumstances of any member of my family.

I declare that:
• I understand it is my responsibility to notify you of any change in circumstances. I understand that the
   Department for Work and Pensions will not do this on my behalf even if I notify them of the change;
• if this form has been filed in by someone else on my behalf, I have read it, or have had it read to me;
• the details on the form are true and complete; and
• I have sought permission from everyone else who lives with me to use their details to process my
   claim.

I give you permission to check any information relating to my claim for benefit.

We must protect the public funds we handle so we may use the information provided on this form to
prevent and detect fraud. We may use this information to promote other council services you may be
entitled to. We may share this information with other organisations which handle public funds for the
same purpose. We may keep information about you on computer. If we do, we will keep to the rules laid
down by the Data Protection Act 1998.


  Signature                                                            Date