HOUSING BENEFIT MISSING CHEQUE FORM

ALL FIELDS MARKED WITH A * ARE REQUIRED ENTRIES

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	HOUSING BENEFIT MISSING CHEQUE FORM
	Use this form to report a lost/ non-received cheque and to request a replacement.
	PLEASE NOTE: THE COUNCIL WILL CONSIDER EACH APPLICATION FOR REIMBURSEMENT ON ITS OWN MERITS AND WILL NOT AUTOMATICALLY REPLACE THE LOST / STOLEN CHEQUE If you would like more information or advice on how to complete this form please telephone us on: 01983 823950
	Your Details

*	Forename
*	Surname

*	Building/house name/number
*	Street address
*	Town Name
	County
*	Postcode
*	Telephone Number (include area code)
	Email address

Fields marked '*' are required entries.

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