Enquiry Form
DSS Accepted - Contact Form
Name : *
Your answer
Surname : *
Your answer
E-mail Address : *
Your answer
Phone Number : *
Your answer
How many people live in your household? *
Only include family members, non-dependents, boarders and sub-tenants who are part of your housing benefit application. If you are not sure who to include, contact the housing benefit department at your local authority.
How many couples are in your household? *
Couples must be members of the same household. They can be married couples, civil partnerships, or two people living together as a couple.
How many single people aged 16 or over live in the household (don’t include anyone in a couple)? *
Include someone not living with you but providing necessary overnight care for you or your partner. If you are not sure who to include, contact the housing benefit department at your local authority.
Male
Female
How many children aged between 10 and 15 (inclusive) live in your household? *
If you are not sure who to include, contact the housing benefit department at your local authority.
Male
Female
How many children aged under 10 live in your household? *
If you are not sure who to include, contact the housing benefit department at your local authority.
Male
Female
Where are you currently living? *
Please select one from the list
Enter a postcode (e.g. CB24 2AE) *
Your answer
Select a local authority *
A partial postcode or local authority search may return more than one result.
Details of Previous Landlord : *
Name, Surname
Your answer
Phone Number of Previous Landlord : *
Your answer
E-mail Address of Previous Landlord : *
Your answer
Postal Address of Previous Landlord *
A valid address with postcode is needed
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.