Title (Mr, Mrs, Miss etc)

First Name

Surname

Address

Post Code

Please give us as much detail as you can about why you think this person is falsely claiming benefit

When do you think the fraud started?

How was your suspicion aroused?

Please give a description of the person who is falsely claiming

Height

Build

Hair (length, style & colour)

Is there another person involved in the false claim?

Yes No

If yes, please give a description of the other person

Sex

Name

Height

Build

Hair (length, style & colour)

If the claimant, partner or other person who is involved in the false claim has a car, please give details

Make/Model

Colour

Registration Number

***Please Note***
By submitting this form you are not giving any of your details (e.g. your email address or anything else by which you can be identified) to Ashfield District Council. The sender of this form will remain anonymous and Ashfield District Council will not attempt to identify the sender, nor will Ashfield District Council store any information other than that asked for in this form.

Thank you for taking the time to give us this information. We appreciate your assistance and will look into this matter.