Council tax: Income and expenditure form | Denbighshire County Council

Before you complete this form

You will need to complete this form to request a special arrangement to repay your Council tax arrears.

You will only need to complete this form if you have council tax arrears for which a court summons has been issued or you have been asked to complete this form so we can assess a suitable arrangement for you.

Your details
Please let us know your details.
First name
Last name
Email address
Phone number
If possible, please provide the council tax reference number:
Your reference number is 9 digits long and can be found at the top right of any correspondence we have sent you.
National Insurance Number
Your address
You can enter a Denbighshire postcode and then select 'Find address' or type in an address below.
Postcode
Address line 1
Address line 2
Address line 3
Address line 4
Address line 5
Please select your employment status:
EmployedSelf-employedUnemployedRetired

Do you receive any state benefits (including child benefits or tax credits)?
YesNo

State benefits
Please let us know about any state benefits you receive.
Attendance Allowance per month
Child Benefit per month
Disability Living Allowance per month
Employment Support Allowance per month
Incapacity Benefit per month
Income Support per month
Job Seekers Allowance per month
Personal Independence Payments per month
Tax Credits per month
Universal Credit per month
Please let us know about any other state benefits you receive including how much and how often you receive them.

Please let us know about the pension you receive including how much and how often you receive it.

Do you have a spouse/partner living at the property with you in the household?
YesNo

What is your spouse's/partner's employment status?
EmployedSelf-employedUnemployed

Spouse's/partner's employment
Please provide your spouse's/partner's employment details.
Business name
Type of business
Business phone number
Business address
Address line 1
Address line 2
Address line 3
Address line 4
Address line 5
Postcode
What is your spouse's/partner's monthly net pay?

Please let us know about any other income your spouse/partner receives, including how much and how often.

Other income
Please let us know about any other income you receive, including the amount and how often you receive it (this includes child maintenance for any children):.
Please let us know about any non-dependant income including how much and how often it's received.

Please provide details of the loans and/or hire purchases you have, including how much you pay a month and when they are due to finish.

Please provide details of any credit cards you have, including how much you pay per month and the current balance.

Please provide details of any other outgoings you have including how much and how often is due out.

Payment proposal

You can make a payment proposal for the amount outstanding.

Submitting this proposal does not mean an arrangement has been agreed. We will contact you to confirm whether or not your proposed payment arrangement has been accepted.
How much can you pay?
How often can you pay?
Any other details
Please tell us any other details you would like us to know.