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:

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:

Who are you reporting for benefit fraud?