Online Benefit Referral Form - Undeclared Income


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:

Undeclared Income

What other income do they have that has not been declared?
Maintainance?	Yes	No
Pension?	Yes	No
Rent from a undeclared lodger?	Yes	No
Please fill in the undeclared persons details below:
Surname of undeclared person:
Forenames of undeclared person:
How long have they been living there?	Years	Months
*
Please use the following boxes to give a description of the undeclared person:
Height:
Age:
Build:
Hair Colour:
Hair Style:
Any Distinguishing features? (tattoos, piercings, facial hair):

*
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 have a key to the property?	Yes	No
What is the relationship between the claimant and lodger?
Please give any further details:
*
Rent from subletting?	Yes	No
Do you know the name of the person who the claimant is sub-letting the property to?	Yes	No
Surname of person the property is let to:
Forenames of person the property is let to:
How long has the property been sub-let?	Years	Months
*
Please use the following boxes to give a description of the person the property is let to:
Height:
Age:
Build:
Hair Colour:
Hair Style:
Any Distinguishing features? (tattoos, piercings, facial hair):
Do you know where the claimant is now living?	Yes	No
House Number:
Street:
Town:
Postcode:
How much rent is being charged?
*
Tax credits?	Yes	No
How long have they been receiving this?	Years	Months
How much do they receive?
How often is this paid?


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