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:

Self-employed and claiming benefits

*
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:


*
Are they self-employed?	Yes No
What is the name of the business?
Is the business run from home or from a business 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:

Who are you reporting for benefit fraud?