Customer accounts - benefits appointee form

CUSTOMER ACCOUNTS –
APPOINTEE FORM
Housing Benefit and Council Tax Benefit
INFORMATION SHEET
If you decide to return the Appointee form we recommend that you keep this information
in a safe place to remind you of your responsibilities.
Who would need an Appointee?
If a Housing Benefit and/or a Council Tax Benefit claimant is unable to manage their
own affairs relating to Housing Benefit and/or Council Tax Benefit, the Local Authority
has the power to appoint someone on their behalf.
The person appointed is known as the Appointee. The claimant may ask for an
Appointee due to mental or physical disability.
How long would the Claimant have an Appointee?
It does not have to be permanent. The Appointee may wish to act on the claimant’s
behalf for a specified time period only, for instance if the claimant is ill or injured.
What responsibilities does the Appointee have?
An Appointee takes over the rights and responsibilities in relation to the claimant’s
Housing Benefit and/or Council Tax Benefit claim.
The Appointee:
1. Accepts full responsibility for completion of the application form.
2. Accepts full responsibility for the information declared on the application form.
3. Accepts that the full obligations placed upon the claimant are also placed upon
the Appointee.
4. Accepts full responsibility for notifying the Customer Accounts section within one
calendar month of any change in circumstance, which may affect Benefit
entitlement.
5. Accepts that they may be required to repay overpayments of Benefit.
6. Must be over the age of 18.
7. Must notify the Customer Accounts section in writing within one month if the
claimant no longer needs an Appointee.
8. Must give one months notice if they no longer wish to be the Appointee.
If they knowingly make a false statement, provide false information or fail to notify a
change of circumstance in order to secure or retain benefit for them self or another
person, it is a criminal offence for which they may be prosecuted.
The Local Authority may terminate this appointment at any time.
CUSTOMER ACCOUNTS –
APPOINTEE FORM
Housing Benefit and Council Tax Benefit
Central Bedfordshire Council
Watling House
High Street North
Dunstable
Bedfordshire
LU6 1LF
Please complete this form and return it to the address above to:
 become an Appointee for a housing benefit and/or council tax benefit claimant.
If you have any questions about this form, please contact us:
Telephone 0300 300 8306
Email [email protected]
www.centralbedfordshire.gov.uk
About the claimant
Claimant’s name
Claimant’s address
Claim reference number
(if known)
About the Appointee
Appointee’s name
Appointee’s address
Appointee’s telephone
number (optional)
Appointee’s email
address (optional)
Please turn over and sign the declaration
Appointee’s declaration
I wish to be appointed by the Council to act on behalf of the above named claimant in
connection with their Housing Benefit and/or Council Tax Benefit until I give further
notice or until
/
/
(please insert date).
The reasons are as follows:
I have read, understood and accept the conditions on the attached information sheet.
Appointee’s
signature
Date
Claimant’s declaration
I request that the above named person is appointed to act on my behalf in connection
with my Housing Benefit and/or Council Tax Benefit.
Claimant’s
signature
Date
If the claimant is unable to sign this form please give details below: