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[null,null,null,null,null,"Rent Arrears Form"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"Guidance"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"This form should be used to request a managed payment to the Landlord and rent arrears deduction, if appropriate; "]
[]
[null,"Personal Details"]
[null,null,null,null,null,null,null,null,null,null,null,null,"- When a Claimant has accrued arrears to the value of two month's rent, we will make managed payments to their Landlord and, if requested, take steps to recover the rent arrears through deductions from the Claimant's Universal Credit payment, if appropriate"]
[null,"Claimant/Tenant Name"]
[]
[null,"Partner Name "]
[]
[null,"Address",null,null,null,null,null,null,null,null,null,null,"- When a Claimant has accrued arrears to the value of one month's rent due to persistent underpayment, we will look at the personal budgeting support the Claimant needs and consider making managed payments to their Landlord, if appropriate. . "]
[]
[]
[]
[null,"Claimant National Insurance Number",null,null,null,null,null,"DoB ","/          /"]
[null,null,null,null,null,null,null,null,null,null,null,null,"The following evidence must be provided before a managed payment and deductions can be considered:"]
[]
[null,"Partner National Insurance Number",null,null,null,null,null,"DoB ","/          /"]
[]
[]
[null,"Amount of rent payable (£)",null,null,null,null,null,null,null,null,null,null,"- Proof of rent arrears which must show the balance on the rent account including the amount of rent outstanding and the amount of rent due each calendar month e.g. Rent book, rent account, letter from Landlord on letter-headed paper confirming the balance on the rent account, including a calculation of the amount of rent outstanding, and the amount of rent due each calendar month."]
[]
[null,"Payment period "]
[null,"(weekly, monthly etc)"]
[]
[null,"Number of rent free weeks  \n(If any)"]
[null,null,null,null,null,null,null,null,null,null,null,null,"'- To enable the request for the managed payments to the Landlord to be linked to the correct Universal Credit claim it is advised that the National Insurance number section be completed.  If the National Insurance number is not known then please provide the tenant(s) Date of Birth  "]
[]
[null,"Amount of arrears (£)"]
[]
[null,"Period over which arrears have accrued"]
[null,null,null,null,null,null,null,null,null,null,null,null,"When completed this form should be returned to:-"]
[]
[null,"Landlord Details",null,null,null,null,null,null,null,null,null,null,"Universal Credit"]
[null,null,null,null,null,null,null,null,null,null,null,null,"Post Handling Site B"]
[null,"Full Name",null,null,null,null,null,null,null,null,null,null,"Wolverhampton"]
[null,null,null,null,null,null,null,null,null,null,null,null,"WV99 1AJ"]
[null,"Address"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"Once we have received the completed form and evidence, a decision will be made whether to make a managed payment and deductions to the Landlord. The Landlord and Claimant will be informed of the decision in writing. "]
[]
[null,"Telephone Number"]
[]
[null,"Bank Account Number"]
[null,"Sortcode",null,null,null," -          -"]
[null,"Account Name"]
[null,"Roll Number (if appropriate)"]
[]
[null,null,null,null,null,null,null,null,null,"PTO"]
[]
[]
[]
[null,"Rent Arrears Cont'd"]
[]
[null,"Do you want to apply for a Third Party Deduction to repay existing rent arrears? Yes/No"]
[]
[]
[null,"If 'Yes' please provide your Department of Work and Pensions creditor "]
[null,"reference number (if known)"]
[]
[null,"Landlord's reference number"]
[]
[null,"Additional information"]
[]
[]
[]
[]
[]
[null,"Completed by:",null,null,"Landlord  \n(Signature)"]
[]
[]
[null,null,null,null,"Tenant / Claimant \n(Signature)"]
[]
[]
[null,null,null,null,"Third Party (Name & Organisation, if appropriate) "]
[]
[]
[]
["FM Rent Arrears Landlord/Claimant Managed Payment Request Form",null,null,null,null,null,null,null,"v1.0   3/14",null,null,"FM Rent Arrears Landlord/Claimant Managed Payment Request Form",null,null,null,null,null,null,null,"v1.0   3/14"]