Online Benefit Referral Form

Who are you reporting for benefit fraud?
Surname:
Forenames:
House Number:
Street:
Town:
Postcode:

How do you know them:
How do you know they are claiming benefits:
What benefits are being claimed:

Living Together

Surname of partner:
Forenames of partner:
How long have they been living there?	Years	Months

Please use the following boxes to give a description of the partner:

Height:
Age:
Build:
Hair Colour:
Hair Style:
Any Distinguishing features? (tattoos, piercings, facial hair):

Do they have an alternative address?	Yes No
House Number:
Street:
Town:
Postcode:

*
Is the partner the father of any children living in the household?	Yes No
Please tell us which children:

*
Do they have any vehicles?	Yes No
Vehicle Registration:
Vehicle Make:
Vehicle Model:
Vehicle Colour:
Do they have access to another vehicle?	Yes No
2nd Vehicle Registration:
2nd Vehicle Make:
2nd Vehicle Model:
2nd Vehicle Colour:
Do they have access to any other vehicles?	Yes No
3rd Vehicle Registration:
3rd Vehicle Make:
3rd Vehicle Model:
3rd Vehicle Colour:
Do they have access to other vehicles?	Yes No
Please give details of any further vehicles here:

*
Do they work for an employer?	Yes No
Who do they work for?
How long have they worked there?	Years	Months
What time do they leave for work?
What time do they get home from work?
Do they have a shift pattern?	Yes No
If yes, please give details
How do they get to work?
Do they wear a uniform?	Yes No
If yes, please give details:

*
Are they self-employed?	Yes No
What is the name of the business?
Is the business run from home or from a buisiness premises?	Business Premises Home

Please give the address of any business premises if known:

Property Number:
Street:
Town:
Postcode:
How long has the business been running?	Years	Months
What type of work do they do?
Do they advertise?	Yes No
If yes, please tell us where:
Please give details of any Other advertising and names of local newspapers or shops they use to advertise:
Do they have a uniform?	Yes No
If yes, please give details:

*
Do they pay towards the bills, food etc?	Yes No
If yes, how much do they pay?
Do they go on holidays together?	Yes No
If yes where and when do they go?
Who does the school run?	Claimant Partner
Do they have a key to the property?	Yes No

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Who are you reporting for benefit fraud?

Living Together

Please use the following boxes to give a description of the partner:

Please give the address of any business premises if known: