Download this form if you want to print it out and fill it in by hand.
Alternatively, complete and submit it online, using our Apply for extra help with your rent or Council Tax form.
What you'll need to complete this form
You must provide:
- bank statements showing the last 30 days from the time you submit your application - you need to provide statements for all bank accounts, building society accounts and savings accounts held for yourself and your partner (if applicable).
- a breakdown of your award from The Department for Work and Pensions if you receive Universal Credit - you can get this from your online journal
Accessibility information
This document may not be suitable if you use assistive technology. Use our contact form to request an accessible format.