Benefit Service
PO Box 34750
London N7 9WF

T 020 7527 4990
F 020 7527 4976

	

Your Name: 

Case No: 

Your Address: 

	
		
Request for Backdated Housing Benefit & Council Tax Benefit/Support

I request that my Housing Benefit/Council Tax Benefit/Support be backdated for the following period: - 

From _____________________  To _____________________

Give reasons why your Housing Benefit/Council Tax Benefit/Support should be backdated, for example “ I was in hospital”

Signed: ________________________  Date: ________________