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Proposal Payment Plan If you are unable to pay the full amount of the housing benefit overpayment as shown on the notice but wish to propose a payment plan to clear the amount owed please complete the following form. *This is a mandatory field. Full Name *This is a mandatory field. Your Full Address *This is a mandatory field. Postcode Address the overpayment relates to, if different to above Daytime Phone Number Mobile Number Email Address *This is a mandatory field. Housing Benefit Claim Number (begins with 1) *This is a mandatory field. Invoice Number (begins with 5) *This is a mandatory field. Employers Name (if not working please enter 'not working') *This is a mandatory field. Your Job Title (if not working please enter N/A) *This is a mandatory field. Full Address of Workplace (if not working please enter N/A) *This is a mandatory field. Payroll Reference Number (if not working please enter N/A) *This is a mandatory field. Expected Net Earnings (after deductions/take home pay) please state whether weekly or monthly: £ (if not working please enter N/A) *This is a mandatory field. Which benefits do you receive? Income Support Job Seekers Allowance ESA Incapacity Benefit DLA Child Benefit Tax Credits Other None Do you receive a pension? Yes No *This is a mandatory field. I wish to propose a payment plan of £ (please state amount) *This is a mandatory field. I wish to commence payment on (please state date) *This is a mandatory field. Please choose a frequency for your payment Weekly Fortnightly Monthly Do you want to make payments by using the Paypoint reference on your demand letter at PayPoint outlets, ? Yes No Do you want to make payments by Direct Debit Yes - Please complete direct debit details below Payment Date for Direct Debit 1st 6th 10th 15th 21st 28th Bank Account no. Bank Sort Code. Name on Bank Account. The council will notify you in due course if your offer to clear the overpayment is acceptable, please note that we may not accept your offer of payment if it will take too long to clear the amount owed. Please use box below if you would like us to consider anything else. .