LHAPAYLL

Rent 8 weeks in

Request for payment of Local Housing Allowance to Landlord

From 7th April 2008 Housing Benefit for private tenants who move or change address will normally be paid to the claimant.

We can only pay your landlord if there are special circumstances which prevent you paying your rent yourself.

If you feel that there is a reason why you cannot manage your own rental payments, please fill in this form and return it to us, with the evidence we need.

Name: ______

Address: ______

______

______

Claim Reference number : ______

Please tick the box or boxes that apply to you and provide the evidence required.

Reason payment to landlord is requested / Examples of evidence
I have learning difficulties that make
it difficult to manage my finances. / Letter from your support provider, your doctor, a social worker etc
I have a medical condition or mental
health problem which makes it
difficult to manage my finances.
/ Letter from your GP, a hospital etc
I will secure / retain my
tenancy through having payments
made direct to my Landlord.
. / Letter from Landlord confirming the agreement you have come to. For example, he has agreed a lower rent.
Reason payment to landlord is requested / Examples of evidence
I am unable to read or write English
and this makes it difficult to manage
my finances
/ Letter from support group, community group etc
I am dealing with addiction to drugs,
alcohol or gambling and this makes
it difficult to manage my finances
. / Letter from your GP, a support worker, a hospital, a care worker, social services etc.
I have recently experienced a
change which makes it difficult for
me to managed my financial affairs
For example bereavement, fleeing
domestic violence, a long period in
hospital, single homeless people,
care leavers, people leaving prison / Letter from your GP, a support worker, a hospital, a care worker, social services, a prison or probation officer etc
I am receiving help under the
Supporting People Scheme and I
have difficulty managing my finances
/ Letter from your GP, a support worker, a hospital, a care worker, social services etc
I have a history of homelessness or
rough sleeping and this makes
it difficult to manage my finances
.
/ Letter from a support worker, a care worker, social services etc
I am receiving help from a
homeless charity and I have difficulty
managing my finances
.
/ Letter from the charity, a support worker, a care worker, social services etc
I have severe debt problems or
recent County Court Judgements
. / Copy of a court order or letter from solicitors, help groups, creditors etc
I am unable to open a bank account
. / Letter from bank, money adviser etc

None of the circumstances above apply, but I have difficulty managing my
financial affairs because

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

• I declare that the information given on this form is correct and complete and I authorise you to make enquiries to check any of the information or evidence I have given.

• I know that I must let you know in writing about any change in my circumstances which might affect my claim.

• I authorise the London Borough of Havering to contact the person / organisation below regarding my request for my Benefit to be paid to my landlord.

Signature

Date

If this form has been completed by someone other than the tenant, please complete this declaration

I declare that, as far as possible, I have confirmed with the tenant that the information I have written on this form is correct.

Name of the person

who filled in the form

Relationship to the tenant

Signature

Date