Kirklees Council Housing Benefit Appeal Form

Title:		
Surname:		
First name:		
Benefit claim number:
(this can be found on your benefit notification letter) 		
Your address:	

	
Post code:		
Daytime telephone number:		
Have you arranged for someone to help you with your appeal?		
If so, please tell us their full name and address:		
Sign to authorise this person to act for you:		

About the decision

What is the date on the letter about the decision you want to appeal against:		
Remember, your appeal should reach our office within one month of the date at the top of your benefit notification letter.	

Tell us why you don’t agree with the decision.

Please print and sign this form: 

Your signature:		
Appointed person’s signature:		
Date:		
What to do now

Make sure you have fully completed this form and told us exactly why you disagree with a decision.
Send your form to us at:
Kirklees Council
Welfare & Exchequer Services
Benefits
PO Box 1720
Huddersfield
HD1 9EL

Or hand it in at any:
•	Customer Service Centre 
•	Library and Information Centre

I am happy to give the personal details required for processing this form. I understand that they will be stored for up 7 years.

I understand that they will be used to determine whether the decision about my housing benefit is correct and may be shared with HM Courts and Tribunal Service and my representative. I understand that I can withdraw or update my details at any time. For more information about how we store your data and how you can request your right to withdraw consent to use your personal data later please read How we use your data.