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CICS Account and case numbers: 55508596 01623514

Please write in black ink.

Revenue Information Details of income from 26DEC06

Mr S Cordell CICDWP/4/DJK
109 Burncroft Avenue 55508596 01623514 Are you working? Yes No
Enfield £
EN3 7JQ If Yes, how much are you paid each week?
020 8379 3798
020 8379 5191 Is your partner working? Yes No
020 8379 4998 If Yes, how much is your partner paid? £
26 April 2007

How many hours do you work?

Dear Mr Cordell
You
Housing and Council Tax Benefit

The Department for Work and Pensions has told me that your Income Your partner
Support ended on 26DEC06. As you have not told me of this change, I have You must enclose payslips. We may contact your employer if your
suspended your benefit. payslips do not provide enough information.
Please write your employer’s name and address:
If you are on a low income, you may still be entitled to some benefit.
Please use the enclosed form to give details of all the income you and your
partner have received since 26DEC06, and enclose the proof requested.

Please supply the information by 10MAY07. You do have up to a month to
supply the information, but the longer you leave it, the longer it will be before
you receive any more benefit. If you do not return the form and supply the
information within one month of the date of this letter, we will have to cancel
your claim.
Did / do you or your partner receive any Yes No
If your circumstances change, you must tell us in writing immediately. If the other income or benefits, such as state
change means you get more benefit, you must tell us about it within one retirement pension, tax credits or incapacity
month. If you do not, the increase will only start from the date you tell us of benefit?
the change. If the change means you get less benefit, it will start from the If Yes, please list them below and provide proof
date of the change. If we pay you too much benefit because you did not tell
us about a change, or told us afterwards, you must pay the money back.
£
Yours sincerely
£
Mr Colin Bullworthy Benefit Operations Manager Visits & Interventions

£

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