Home My Account Report a change in circumstances

Reference number:NOGKLGPMAD

This form was started at: 18/08/2017 15:13:20

This form was completed at: 18/08/2017 17:59:33

Internal form classification: 6

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 Home My Account Report a change in circumstances

Tell us who you are Reference number:NOGKLGPMAD

Title Mr

Firstname Simon

Surname Brewer

Are you male or female Male

Date of birth 04/01/1971

Address line 1 82 Burns Road

Address line 2 Harlesden

Address line 3 London

Address line 4

Postcode NW10 4DY

National insurance number NW600027C

Claimant's telephone number 020 89611312

Mobile telephone number

Valid Email address - this must be supplied simoncbrewer@hotmail.com

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 Home My Account Report a change in circumstances

Current claim details Reference number:NOGKLGPMAD

We've found your details

Here is a summary of your existing claim. Please have a read through and use the next page to tell us about what has changed.

Your existing claim reference number: 2081774

The address where you made the claim: 82 Burns Road

Harlesden

London

NW10 4DY

Use the next button to start telling us about the changes in your circumstance.

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 Home My Account Report a change in circumstances

What has changed Reference number:NOGKLGPMAD

Please look at the options below and select any that apply to you or any member of your household

Please answer the questions below. We will ask for more detail about each change you confirm on subsequent pages.

Have you moved to a new home? Yes No

Has anyone new joined your household? Yes No

Has a member of your household become a student in higher education? Yes No

Has anyone had a change to their income? Yes No

Has your landlord changed the rent? Yes No

Has anyone had a change to their savings or capital? Yes No

Have you or your partner had a change to the amount you recieve from your Yes No

occupational pension

Has there been a change to the amount you pay out for any of the following: Childcare Yes No

Costs; Private Pension; Upkeep of a Student

Are you temporarily living away from home? Yes No

Are there any other changes you need to tell us about that are not listed above? Yes No

Please tell us how you found out you should report a change CouncilWebsite

Please only select the 'other changes' option if NONE of the other options apply to you or someone in your household

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 Home My Account Report a change in circumstances

Whose income has changed Reference number:NOGKLGPMAD

Household member name Simon Christopher Brewer

Has this person become self-employed? Yes No

Has this person started any new jobs, including self employment Yes No

Has this person started receiving any new incomes other than the new income already Yes No

stated above?

Has this person begun recieving Statutory Sick Pay? Yes No

Has this person begun recieving Statutory Maternity Pay? Yes No

Has this person begun recieving Statutory Paternity Pay? Yes No

Has this person begun receiving Universal Credit? Yes

No

On what date did this change occur? 28/07/2017

Are there any other details about this change you need to tell us? This is for income based jobseeker's allowance which I have just received
an award letter for, and which I have scanned. I will send the scan via

email as neither pdf or jpg will upload on this form. The standard

allowance on the following page is the weekly payment of JSA.

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 Home My Account Report a change in circumstances

Reference number:NOGKLGPMAD

Please provide the following details regarding your new Universal Credit.

Your Standard Allowance: 73.10

Housing element:

Child element:

Disabled child element:

Childcare element:

Carer element:

Limited Capability for Work element:

Total of any non-work income and other benefits you receive, as well as your savings

and capital:

The total we take off for take-home pay is:

The total we take off for any loans, advances, sanctions, penalties, deductions,

overpayments or third party payments you have is:

Total Universal Credit monthly payment for this period: 73.10

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 Home My Account Report a change in circumstances

Evidence Reference number:NOGKLGPMAD

We need you to provide the following documents to support your claim and confirm the details you have supplied in your application. These documents can be
originals or photocopies.

Add Evidence

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 Home My Account Report a change in circumstances

Declaration Reference number:NOGKLGPMAD

Review your answers

Before submitting your form you can review all of the answers you have given so far by clicking on the link below.

Open a read only view of the answers you have given (this will open in a new window)

Evidence Checklist

A list of required evidences is available from the link below.

Open the evidence list (this will open in a new window)

Declaration

By submitting this claim you are agreeing to the following declaration. To view this declaration please click on the link below

Open the declaration form (this will open in a new window)

I have read and agree to the declaration and I confirm that all of the details I have
provided are correct

Now submit your form using the submit button below.

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