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. e can only pay your landlord if there are special circumstances which prevent you paying your rent yourself. !f 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. #ame$ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Address$ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% &laim 'eference number $ %%%%%%%%%%%%%%%% Please tick the box or boxes that apply to you and pro ide the e idence required! Reason payment to landlord is requested ! have learning difficulties that ma(e it difficult to manage my finances. ! have a medical condition or mental health problem which ma(es it difficult to manage my finances. ! will secure , retain my tenancy through having payments made direct to my )andlord. . "xamples of e idence )etter from your support provider" your doctor" a social wor(er etc

)etter from your *+" a hospital etc

)etter from )andlord confirming the agreement you have come to. For e-ample" he has agreed a lower rent.

Reason payment to landlord is requested ! am unable to read or write .nglish and this ma(es it difficult to manage my finances ! am dealing with addiction to drugs" alcohol or gambling and this ma(es it difficult to manage my finances . ! have recently e-perienced a change which ma(es it difficult for me to managed my financial affairs For e-ample bereavement" fleeing domestic violence" a long period in hospital" single homeless people" care leavers" people leaving prison ! am receiving help under the /upporting +eople /cheme and ! have difficulty managing my finances

"xamples of e idence )etter from support group" community group etc

)etter from your *+" a support wor(er" a hospital" a care wor(er" social services etc. )etter from your *+" a support wor(er" a hospital" a care wor(er" social services" a prison or probation officer etc

)etter from your *+" a support wor(er" a hospital" a care wor(er" social services etc

! have a history of homelessness or rough sleeping and this ma(es it difficult to manage my finances . ! am receiving help from a homeless charity and ! have difficulty managing my finances . ! have severe debt problems or recent &ounty &ourt 0udgements . ! am unable to open a ban( account .

)etter from a support wor(er" a care wor(er" social services etc

)etter from the charity" a support wor(er" a care wor(er" social services etc

&opy of a court order or letter from solicitors" help groups" creditors etc )etter from ban(" money adviser etc

#one of the circumstances above apply" but ! 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 ! authorise you to ma(e en1uiries to chec( any of the information or evidence ! have given. I know that ! must let you (now 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. #ignature $ate %f this form has been completed by someone other than the tenant& please complete this declaration % declare that" as far as possible" ! have confirmed with the tenant that the information ! have written on this form is correct. 'ame of the person who filled in the form Relationship to the tenant #ignature $ate