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Discretionary Housing Payment Application Form

Page 1 of 7

About you

To assess your DHP application we will need you to upload the following evidence in Section 4 of the form.

If you receive Universal Credit, a full breakdown of your UC award
Proof of your rent i.e your tenancy agreement or rent statement

If you do not have this evidence available to upload at the time of completing the application you can send it later at our evidence upload page.

After you have submitted your form, you may need you to provide further information e.g., bank statements to support your application. We will contact you to ask for this if we need to.

First Name: *

Surname: *

Date of Birth: *

National Insurance Number (NINO):

Benefit claim number:

Email:

Phone Number:

Address: *

Postcode: *

When did you move into your current address?

Completing the form for someone else

Are you completing this form on behalf of someone else?

Yes, I am completing this form on behalf of someone else
No, I am completing this form for myself

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