Benefit Fraud Reporting Form

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East Lindsey District Council

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Benefit Fraud Reporting Form

If you suspect someone of benefit fraud, please complete as much of the form as you can.

Do not worry if you don't know the answers to some of the questions
All the information you provide will be strictly in confidence and although you do not have to give us your name and address, you can if you wish
Make sure that you are not being watched while you are filling out the form to keep the information as confidential as possible
If you print out a copy of the completed form - keep this safe

Section 1: About the person claiming benefit

1a. What type of benefit fraud do you think is being committed?
Type:
Other information about type of fraud:
	For example: if living together when did this start? If the couple have children please give details of names, sex, age and so on.
What makes you think fraud is being committed:

1b. Who do you suspect of benefit fraud?
Their surname or family name:
Their forenames:
Their title (for example Mr, Mrs, Ms):
Their other names, nicknames, aliases:
Their address:
Their postcode:
Their phone number:
Their gender:
Their National Insurance number (if known):
What is their date of birth or age:
What benefits are involved:
Other Benefit Details:

1c. Appearance of person claiming benefit
Their ethnic group:
Other ethnic group details:
Their build:
Their eye colour:
Their eyewear:
Their hair colour:
Other Details:
Their hairtype:
Their distinguishing features:
	For example: facial hair, tattoos, scars, piercings
Other details about their appearance:
	Such as their usual style of clothing (for example, always wears jeans) or distinctive jewellery

1d. Their employment (Only complete if the claimant is employed)
Do you think the employer knows:
Their employers name and address (if known):
Other details about their employment:
	For example: Type of work, times, dress, how much they earn, which days they work

1e. Their vehicle details (if applicable)
Make and Model:
Registration Number:
Colour:
Other features:

Section 2: About the partner of the person claiming benefits
2a. If different from above, what type of benefit fraud do you think is being committed?
Type:
Other information about type of fraud:

2b. What is the name of the partner?
Their surname or family name:
Their forenames:
Their title (for example Mr, Mrs, Ms):
Their other names, nicknames, aliases:
Their gender:
Their address:
	If same as above, please enter 'Same as above'
Their postcode:
	If same as above, please enter 'Same as above'
Their phone number:
Their National Insurance number (if known):
Their date of birth or age:
Which benefits are involved:
Other benefit details:

2c. Appearance of partner?
Their ethnic group:
Other ethnic group details:
Their build:
Their eyecolour:
Their eyewear:
Their hair colour:
Other details:
Their hairtype:
Other hairtype (if applicable):
Their distinguishing features:
	For example: facial hair, tattoos, scars, piercings
Other information on appearance:
	Such as their usual style of clothing (for example, always wears jeans) or distinctive jewellery

2d. Their employment (Only complete if the partner is employed)
Do you think their employer knows:
Their employers name and address (if known):
Other details about their work:
	For example: type of work, times, dress, how much they earn, which days they work

2e. Partner's Vehicle Details (if applicable)
Make and Model:
Registration Number:
Colour:
Other features:

Section 3: About you
The information you have provided is strictly confidential. You do not need to tell us who you are, but if you would like our investigators to be able to contact you for more information, please tell us:
Your name:
Your address:
Your phone number:
Email:

Section 4: Other details
Other details: