Forms home Council Tax Financial Questionnaire Step 1 of 63 1% You are being asked to provide a clear, complete, and accurate picture of your current and recent financial situation for your request to repay your Council Tax arrears. You must include details of anyone who also shares financial responsibility with you.Council tax detailsIs your council tax reference an 8 or 11 digit number?(Required) 8 digit reference number 11 digit reference number Please enter your 8 digit council tax reference number(Required) Please enter your 11 digit council tax reference number(Required) My details Title(Required)Please selectMrMrsMissMsMxOtherIf other, please specify Title(Required) First name(Required) Last name(Required) Other names Do you live in Redbridge ?(Required) Yes No Enter Postcode(Required)Find addressSelected address Address(Required) Address Line 1 Address Line 2 Town or City AberdeenshireAngus/ForfarshireArgyllshireAyrshireBanffshireBedfordshireBerkshireBerwickshireBlaenau GwentBridgendBuckinghamshireButeshireCaerphillyCaithnessCambridgeshireCardiffCarmarthenshireCeredigionCheshireClackmannanshireConwyCornwallCromartyshireCumberlandDenbighshireDerbyshireDevonDorsetDumfriesshireDunbartonshire/DumbartonshireDurhamEast Lothian/HaddingtonshireEssexFifeFlintshireGloucestershireGwyneddHampshireHerefordshireHertfordshireHuntingdonshireInverness-shireIsle of AngleseyKentKincardineshireKinross-shireKirkcudbrightshireLanarkshireLancashireLeicestershireLincolnshireLondonMerthyr TydfilMiddlesexMidlothian/EdinburghshireMonmouthshireMorayshireNairnshireNeath Port TalbotNewportNorfolkNorthamptonshireNorthumberlandNottinghamshireOrkneyOxfordshirePeeblesshirePembrokeshirePerthshirePowysRenfrewshireRhondda Cynon TaffRoss-shireRoxburghshireRutlandSelkirkshireShetlandShropshireSomersetStaffordshireStirlingshireSuffolkSurreySussexSutherlandSwanseaTorfaenVale of GlamorganWarwickshireWest Lothian/LinlithgowshireWestmorlandWigtownshireWiltshireWorcestershireWrexhamYorkshire County Postcode My contact detailsContact telephone number(Required) Alternative contact number Enter Email(Required) Marital statusMarital status(Required) Single Married Partner Separated Divorced Widowed Spouse/Partner detailsTitle(Required)Please selectMrMrsMissMsMxOtherIf other, please specify(Required) First name(Required) Last name(Required) Other names Contact telephone number(Required) Alternative contact number Enter Email Your Employment detailsAre you currently in employment ?(Required) Yes No Are you self employed?(Required) Yes No Your self employment details Name of business(Required) Type of business(Required) Business address(Required) Address Line 1 Address Line 2 Town or City AberdeenshireAngus/ForfarshireArgyllshireAyrshireBanffshireBedfordshireBerkshireBerwickshireBlaenau GwentBridgendBuckinghamshireButeshireCaerphillyCaithnessCambridgeshireCardiffCarmarthenshireCeredigionCheshireClackmannanshireConwyCornwallCromartyshireCumberlandDenbighshireDerbyshireDevonDorsetDumfriesshireDunbartonshire/DumbartonshireDurhamEast Lothian/HaddingtonshireEssexFifeFlintshireGloucestershireGwyneddHampshireHerefordshireHertfordshireHuntingdonshireInverness-shireIsle of AngleseyKentKincardineshireKinross-shireKirkcudbrightshireLanarkshireLancashireLeicestershireLincolnshireLondonMerthyr TydfilMiddlesexMidlothian/EdinburghshireMonmouthshireMorayshireNairnshireNeath Port TalbotNewportNorfolkNorthamptonshireNorthumberlandNottinghamshireOrkneyOxfordshirePeeblesshirePembrokeshirePerthshirePowysRenfrewshireRhondda Cynon TaffRoss-shireRoxburghshireRutlandSelkirkshireShetlandShropshireSomersetStaffordshireStirlingshireSuffolkSurreySussexSutherlandSwanseaTorfaenVale of GlamorganWarwickshireWest Lothian/LinlithgowshireWestmorlandWigtownshireWiltshireWorcestershireWrexhamYorkshire County Postcode Telephone number(Required) Your Employer details Name of Employer(Required) Employers address Address Line 1 Address Line 2 Town or City AberdeenshireAngus/ForfarshireArgyllshireAyrshireBanffshireBedfordshireBerkshireBerwickshireBlaenau GwentBridgendBuckinghamshireButeshireCaerphillyCaithnessCambridgeshireCardiffCarmarthenshireCeredigionCheshireClackmannanshireConwyCornwallCromartyshireCumberlandDenbighshireDerbyshireDevonDorsetDumfriesshireDunbartonshire/DumbartonshireDurhamEast Lothian/HaddingtonshireEssexFifeFlintshireGloucestershireGwyneddHampshireHerefordshireHertfordshireHuntingdonshireInverness-shireIsle of AngleseyKentKincardineshireKinross-shireKirkcudbrightshireLanarkshireLancashireLeicestershireLincolnshireLondonMerthyr TydfilMiddlesexMidlothian/EdinburghshireMonmouthshireMorayshireNairnshireNeath Port TalbotNewportNorfolkNorthamptonshireNorthumberlandNottinghamshireOrkneyOxfordshirePeeblesshirePembrokeshirePerthshirePowysRenfrewshireRhondda Cynon TaffRoss-shireRoxburghshireRutlandSelkirkshireShetlandShropshireSomersetStaffordshireStirlingshireSuffolkSurreySussexSutherlandSwanseaTorfaenVale of GlamorganWarwickshireWest Lothian/LinlithgowshireWestmorlandWigtownshireWiltshireWorcestershireWrexhamYorkshire County Postcode Telephone number(Required) Spouse/Partner Employment detailsIs your Spouse/Partner currently in employment ?(Required) Yes No Is your Spouse/Partner self-employed?(Required) Yes No Your Spouse/Partner's self employment detailsName of business(Required) Type of business(Required) Business address(Required) Address Line 1 Address Line 2 Town or City AberdeenshireAngus/ForfarshireArgyllshireAyrshireBanffshireBedfordshireBerkshireBerwickshireBlaenau GwentBridgendBuckinghamshireButeshireCaerphillyCaithnessCambridgeshireCardiffCarmarthenshireCeredigionCheshireClackmannanshireConwyCornwallCromartyshireCumberlandDenbighshireDerbyshireDevonDorsetDumfriesshireDunbartonshire/DumbartonshireDurhamEast Lothian/HaddingtonshireEssexFifeFlintshireGloucestershireGwyneddHampshireHerefordshireHertfordshireHuntingdonshireInverness-shireIsle of AngleseyKentKincardineshireKinross-shireKirkcudbrightshireLanarkshireLancashireLeicestershireLincolnshireLondonMerthyr TydfilMiddlesexMidlothian/EdinburghshireMonmouthshireMorayshireNairnshireNeath Port TalbotNewportNorfolkNorthamptonshireNorthumberlandNottinghamshireOrkneyOxfordshirePeeblesshirePembrokeshirePerthshirePowysRenfrewshireRhondda Cynon TaffRoss-shireRoxburghshireRutlandSelkirkshireShetlandShropshireSomersetStaffordshireStirlingshireSuffolkSurreySussexSutherlandSwanseaTorfaenVale of GlamorganWarwickshireWest Lothian/LinlithgowshireWestmorlandWigtownshireWiltshireWorcestershireWrexhamYorkshire County Postcode Telephone number(Required) Your Spouse/Partner's Employer detailsName of the Employer(Required) Employer's address Address Line 1 Address Line 2 Town or City AberdeenshireAngus/ForfarshireArgyllshireAyrshireBanffshireBedfordshireBerkshireBerwickshireBlaenau GwentBridgendBuckinghamshireButeshireCaerphillyCaithnessCambridgeshireCardiffCarmarthenshireCeredigionCheshireClackmannanshireConwyCornwallCromartyshireCumberlandDenbighshireDerbyshireDevonDorsetDumfriesshireDunbartonshire/DumbartonshireDurhamEast Lothian/HaddingtonshireEssexFifeFlintshireGloucestershireGwyneddHampshireHerefordshireHertfordshireHuntingdonshireInverness-shireIsle of AngleseyKentKincardineshireKinross-shireKirkcudbrightshireLanarkshireLancashireLeicestershireLincolnshireLondonMerthyr TydfilMiddlesexMidlothian/EdinburghshireMonmouthshireMorayshireNairnshireNeath Port TalbotNewportNorfolkNorthamptonshireNorthumberlandNottinghamshireOrkneyOxfordshirePeeblesshirePembrokeshirePerthshirePowysRenfrewshireRhondda Cynon TaffRoss-shireRoxburghshireRutlandSelkirkshireShetlandShropshireSomersetStaffordshireStirlingshireSuffolkSurreySussexSutherlandSwanseaTorfaenVale of GlamorganWarwickshireWest Lothian/LinlithgowshireWestmorlandWigtownshireWiltshireWorcestershireWrexhamYorkshire County Postcode Telephone number(Required) Property detailsDo you own the property that you are residing in?(Required) Yes No Is the property jointly owned?(Required) Yes No Name of joint owner Telephone Number Other property detailsDo you own/jointly own any other properties (including any overseas)?(Required) Yes No Is your property in Redbridge?(Required) Yes No Enter Postcode(Required)Find addressSelected address Address of other property owned(Required) Household detailsPlease list all the people who live in your home (other than you) Name Relationship to you (e.g. partner, son, daughter) Date of birth Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Please list all the people who live in your home (other than you and your Spouse/Partner) Name Relationship to you (e.g. partner, son, daughter) Date of birth Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Your monthly Income and BenefitsSalary and WagesUniversal creditJobseekers Allowance (Income Based)Jobseekers Allowance (Contribution based)Income SupportWorking Tax CreditChild Tax CreditChild BenefitEmployment and Support Allowance or StatutorySick PayDisability benefitsCarers AllowanceLocal Housing Allowance/Housing BenefitCouncil Tax supportOther benefits/tax credits (e.g.maternity benefits (MN)Private pensionGrants/loans/bursaryRental/boardOther income Your Spouse/Partner's monthly Income and BenefitsSalary and WagesUniversal CreditJobseekers Allowance (Income Based)Jobseekers Allowance (Contribution based)Income SupportWorking Tax CreditChild Tax CreditChild BenefitEmployment and Support Allowance or StatutorySick PayDisability benefitCarers AllowanceLocal Housing Allowance/Housing BenefitCouncil Tax SupportOther benefits/tax credits (e.g.maternity benefits (MN)Private pensionGrants/loans/bursaryRental/boardOther income Your monthly Expenditure MortgageRentService ChargesSecured LoansNon - Secured LoansCredit CardsCouncil TaxWaterGas/ElectricTelephonesMobileInternetSatellite/CableTV/LicenceChild MaintenanceChild care costsBuildings/Contents InsuranceLife InsuranceCar InsuranceRoad TaxFuelPublic Transport faresHousehold ShoppingAny other expenditure Your Spouse/Partner's monthly Expenditure MortgageRentService ChargesSecured LoansNon - Secured LoansCredit CardsCouncil TaxWaterGas/ElectricTelephonesMobileInternetSatellite/CableTV/LicenceChild MaintenanceChild care costsBuildings/Contents InsuranceLife InsuranceCar InsuranceRoad TaxFuelPublic Transport faresHousehold ShoppingAny other expenditure Your monthly expenditure Monthly expenditure Mortgage Rent Service Charges Secured Loans Non - Secured Loans Credit Cards Council Tax Water Gas/Electric Telephones Mobile Internet Satellite/Cable TV/Licence Child Maintenance Child care costs Buildings/Contents Insurance Life Insurance Car Insurance Road Tax Fuel Public Transport fares Household Shopping Any other expenditure Monthly expenditure: MortgagePlease specify the mortgage you pay(Required) Monthly expenditure: RentPlease specify the rent you pay Monthly expenditure: Services chargesPlease specify the service charges you pay Monthly expenditure: Secured loansPlease specify the secured loans you pay Monthly expenditure: Non secured loansPlease specify the non secured loans you pay Monthly expenditure: Credit cardsPlease specify the credit cards you pay Monthly expenditure: Council taxPlease specify the council tax you pay Monthly expenditure: WaterPlease specify the water charges you pay Monthly expenditure: Gas/ElectricPlease specify the gas/electric charges you pay Monthly expenditure: TelephonePlease specify the telephone charges you pay Monthly expenditure: MobilePlease specify the mobile charges you pay Monthly expenditure: InternetPlease specify the internet charges you pay Monthly expenditure: Satellite/CablePlease specify the satellite/cable charges you pay Monthly expenditure: TV licencePlease specify the TV licence charges you pay Monthly expenditure: Child maintenancePlease specify the child maintenance you pay Monthly expenditure: Child care costsPlease specify the child care costs you pay Monthly expenditure: Buildings/Contents insurancePlease specify the buildings/contents insurance you pay Monthly expenditure: Life insurancePlease specify the life insurance you pay Monthly expenditure: Car insurancePlease specify the car insurance you pay Monthly expenditure: Road tax Please specify the road tax you pay Monthly expenditure: FuelPlease specify the fuel charges you pay Monthly expenditure: Public transport faresPlease specify the public transport fares you pay Monthly expenditure: Household Shopping Please specify the household shopping you pay Monthly expenditure: Household Shopping Specify any other expenditureConfiguration RequiredUse the Nested Form and Summary Fields settings to choose the form and fields to display in this Nested Form field. Your spouse/partner's monthly expenditurePlease select your spouse/partner's monthly expenditure Mortgage Rent Service Charges Secured Loans Non - Secured Loans Credit Cards Council Tax Water Gas/Electric Telephones Mobile Internet Satellite/Cable TV/Licence Child Maintenance Child care costs Buildings/Contents Insurance Life Insurance Car Insurance Road Tax Fuel Public Transport fares Household Shopping Any other expenditure Monthly expenditure: Mortgage your spouse/partner payPlease specify the mortgage your spouse/partner pay(Required) Monthly expenditure: Rent your spouse/partner payPlease specify the rent your spouse/partner pay(Required) Monthly expenditure: Service charges your spouse/partner payPlease specify the service charges your spouse/partner pay(Required) Monthly expenditure: Secured loans your spouse/partner payPlease specify the secured loans your spouse/partner pay(Required) Monthly expenditure: Non secured loans your spouse/partner payPlease specify the non secured loans your spouse/partner pay(Required) Monthly expenditure: Credit cards your spouse/partner payPlease specify the Credit cards your spouse/partner pay(Required) Monthly expenditure: Council tax your spouse/partner payPlease specify the Council tax your spouse/partner pay(Required) Monthly expenditure: Water charges your spouse/partner paysPlease specify the Water charges your spouse/partner pay(Required) Monthly expenditure: Gas/Electric charges your spouse/partner paysPlease specify the Gas/Electric charges your spouse/partner pay(Required) Monthly expenditure: Telephones charges your spouse/partner paysPlease specify the Telephones charges your spouse/partner pay(Required) Monthly expenditure: Mobile charges your spouse/partner paysPlease specify the Mobile charges your spouse/partner pay(Required) Monthly expenditure: Internet charges your spouse/partner paysPlease specify the Internet charges your spouse/partner pay(Required) Monthly expenditure: Satellite/Cable charges your spouse/partner paysPlease specify the Satellite/Cable charges your spouse/partner pay(Required) Monthly expenditure: TV license your spouse/partner paysPlease specify the TV license charges your spouse/partner pay(Required) Monthly expenditure: Child maintenance your spouse/partner paysPlease specify the Child maintenance your spouse/partner pay(Required) Monthly instalment payment offerWhat is your offer of a monthly instalment payment?(Required) Your offer is not guaranteed as being accepted and any offer agreed is also subject to periodic reviews. Written confirmation of agreement will be either e-mailed or posted within 14 days of being received. You should make some form of payment whilst your request is being dealt with. Are you completing this form for yourself?(Required) Yes No, I am making the referral on behalf of someone What is your relationship to the person being referred?(Required) Carer Family/friend Redbridge Council staff Other ... if other, please specify(Required) Title(Required)Please selectMrMrsMissMsMxOtherif other, please specify(Required) First name(Required) Last name(Required) Other names Contact telephone number(Required) Alternative contact number Email DeclarationDeclaration(Required) I declare that I have read each question to the claimant and recorded the answers given by them. As far as I know, they are true and complete.Declaration(Required) I declare that the information I have given is complete and accurate to the best of my knowledge. I understand that the Council may check the information against other data sources and that the option to pay by instalments may be withdrawn if I knowingly supply false information.