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Disclosure of Information Form

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Date:

Your Ref:

My Ref:

When calling or telephoning please ask for the Benefits Section.
Town Hall
Avenue Road
Lymington
HANTS SO41 9ZG

Tel: 01590 646121
 

HOUSING BENEFITS

The Council is obliged to keep confidential the information provided by you in respect of your Housing Benefit Claim. If you require another person, for example, the Citizens Advice Bureau or a Solicitor or a member of your family to assist in dealing with your Housing Benefit Claim and they require some information provided by you from the Council, it is necessary for you to give written authorisation for the Council to give this information to the other person.

The form of authorisation is set out below and such a form must be completed by you and returned to the Council before the Council's Officers can disclose personal information concerning your application to another person.

1. Do you require full details to be disclosed?     YES/NO
2. If not, specify what information you wish to be disclosed:

3. Do you want the authorisation to last for an indefinite period?     YES/NO
4. If not please specify how long you want the authorisation to last:


I authorise New Forest District Council to disclose information concerning my Housing Benefit Claim to:-

Name ...........................................................................................................................................

Address .......................................................................................................................................

....................................................................................................................................................

Signed.........................................................................................................
Date.........................................................................................................
Full Name.........................................................................................................
Address.........................................................................................................
 .........................................................................................................
Updated: 27 Feb 2015
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