APPLICATION FOR A DISCRETIONARY HOUSING PAYMENT

ALL FIELDS MARKED WITH A * ARE REQUIRED ENTRIES

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	APPLICATION FOR A DISCRETIONARY HOUSING PAYMENT
	Use this form to apply for additional help with Housing Benefit or Council Tax benefit.
	Your Details

Housing Benefit Reference

*	Building/house name/number
*	Street address
*	Town Name
	County
*	Postcode
	Telephone Number (include area code)
	Email address
*	Are you applying for additional help with	your rent your council tax

Fields marked '*' are required entries.

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