Free Late Rent Notice Template 19Free Late Rent Notice Template 19
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LHA23 D 06/07
Office stamp

Local
Housing Allowancepplicatpayment of Local
Housing Allowane to yor landlord
Claim reference number if known

Rent 8 weeks in arrears – pro-forma
Under the Local Housing Allowance (LHA) scheme, we will usually pay benefit to a tenant. A tenant must
then pay the rent to their landlord. If the tenant is 8 weeks or more in arrears with their rent, the law allows
for payment of Local Housing Allowance to be made directly to the landlord unless it is in the overriding
interests of the claimant or his family not to do so.
Please fill in this form and return it to us, together with the proof we ask for. We will send you our decision
as soon as we can. Please note that if you cannot send the proof we ask for, it may delay our decision. This
may mean that payments will continue to be made to your tenant.

About the tenant
Surname or family name
Other names
Address

Postcode
Phone number

About the landlord
Landlord’s Name
Address

Postcode
Phone number

Appendix 5