Housing and Council Tax Benefit

Fraud Referral Form

Type of Benefit Fraud What type of benefit fraud do you think is being committed?*

Other information about the type of benefit fraud being committed? For example, if living together when did this start? If the couple have children please give full details of names, sex, age and so on.*

What makes you think benefit fraud is being committed?*

About the person claiming benefit Their surname or family name*

Their gender*

Their forenames*

Their title (for example,Mr, Mrs, Ms)

Their other names, nicknames, aliases

Their address*

Their postcode

Their phone number

Their National Insurance number (if known)

What is their date of birth or estimated age?*

Which benefits are involved? Please choose one from this list

Details of other benefits involved

Appearance of person claiming benefit Their ethnic group: Please choose one from this list

Provide any other information if necessary.

Their build: Please choose one from this list

Their eye colour: Please choose one from this list

Their eyewear: Please choose one from this list

Their hair colour: Please choose one from this list

Their hair type: Please describle hairstyle

Provide any other information if necessary.

Their distinguishing features (for example, facial hair, tattoos, scars, piercings.)

Other information about their appearance? (Such as their usual style of clothing for example always wears jeans, or distinctive jewellery.)

Their employment If they are working, do you think their employer knows they are fraudulently claiming benefit?

Their employer’s name and address if known

Other details, about their work? (for example, type of work, times, dress, how much they earn, which days they work.)

Their vehicle details Make and model

Registration number

Colour

Other features

Their Partner Does the claimant have a partner?

About the partner of the person claiming benefits If different from above, what type of benefit fraud do you think is being committed?*

Other information about the type of benefit fraud being committed?

Partner’s Details Their surname or family name

Their gender*

Their forenames

Their title (for example,Mr, Mrs, Ms)

Their other names, nicknames, aliases

Their address

Their postcode

Their phone number

Their National Insurance number (if known)

What is their date of birth or estimated age?

Which benefits are involved? Please choose one from this list*

Details of other benefits involved

Appearance of partner Their ethnic group: Please choose one from this list

Provide any other information if necessary.

Their build: Please choose one from this list

Their eye colour: Please choose one from this list

Their eyewear: Please choose one from this list

Their hair colour: Please choose one from this list

Their hair type: Please describle hairstyle

Provide any other information if necessary.

Their distinguishing features (for example, facial hair, tattoos, scars, piercings.)

Other information about their appearance? (Such as their usual style of clothing for example always wears jeans, or distinctive jewellery.)

Partners employment If they are working, do you think their employer knows they are fraudulently claiming benefit?

Their employer’s name and address if known

Other details, about their work? (for example, type of work, times, dress, how much they earn, which days they work.)

Partner’s vehicle details

If same as above, please enter ’same as above’ in each box.

Make and model

Registration number

Colour

Other features

About You

The information you have provided is strictly confidential. You do not need to tell us who you are, but if you would like our investigators to be able to contact you for more information, please tell us.

Your name

Your address

Your phone number

Your email address

Other Details Is there anything else we should know?

* Required Field

Thank you for the information you have provided. For reasons of confidentiality, we will not be able to tell you the result of our enquiries.

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	Housing and Council Tax Benefit Fraud Referral Form Type of Benefit Fraud What type of benefit fraud do you think is being committed?* Other information about the type of benefit fraud being committed? For example, if living together when did this start? If the couple have children please give full details of names, sex, age and so on.* What makes you think benefit fraud is being committed?* About the person claiming benefit Their surname or family name* Their gender* Their forenames* Their title (for example,Mr, Mrs, Ms) Their other names, nicknames, aliases Their address* Their postcode Their phone number Their National Insurance number (if known) What is their date of birth or estimated age?* Which benefits are involved? Please choose one from this list Details of other benefits involved Appearance of person claiming benefit Their ethnic group: Please choose one from this list Provide any other information if necessary. Their build: Please choose one from this list Their eye colour: Please choose one from this list Their eyewear: Please choose one from this list Their hair colour: Please choose one from this list Their hair type: Please describle hairstyle Provide any other information if necessary. Their distinguishing features (for example, facial hair, tattoos, scars, piercings.) Other information about their appearance? (Such as their usual style of clothing for example always wears jeans, or distinctive jewellery.) Their employment If they are working, do you think their employer knows they are fraudulently claiming benefit? Their employer’s name and address if known Other details, about their work? (for example, type of work, times, dress, how much they earn, which days they work.) Their vehicle details Make and model Registration number Colour Other features Their Partner Does the claimant have a partner? About the partner of the person claiming benefits If different from above, what type of benefit fraud do you think is being committed?* Other information about the type of benefit fraud being committed? Partner’s Details Their surname or family name Their gender* Their forenames Their title (for example,Mr, Mrs, Ms) Their other names, nicknames, aliases Their address Their postcode Their phone number Their National Insurance number (if known) What is their date of birth or estimated age? Which benefits are involved? Please choose one from this list* Details of other benefits involved Appearance of partner Their ethnic group: Please choose one from this list Provide any other information if necessary. Their build: Please choose one from this list Their eye colour: Please choose one from this list Their eyewear: Please choose one from this list Their hair colour: Please choose one from this list Their hair type: Please describle hairstyle Provide any other information if necessary. Their distinguishing features (for example, facial hair, tattoos, scars, piercings.) Other information about their appearance? (Such as their usual style of clothing for example always wears jeans, or distinctive jewellery.) Partners employment If they are working, do you think their employer knows they are fraudulently claiming benefit? Their employer’s name and address if known Other details, about their work? (for example, type of work, times, dress, how much they earn, which days they work.) Partner’s vehicle details If same as above, please enter ’same as above’ in each box. Make and model Registration number Colour Other features About You The information you have provided is strictly confidential. You do not need to tell us who you are, but if you would like our investigators to be able to contact you for more information, please tell us. Your name Your address Your phone number Your email address Other Details Is there anything else we should know? * Required Field Thank you for the information you have provided. For reasons of confidentiality, we will not be able to tell you the result of our enquiries.
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