North Warwickshire Housing referral from

* Required Fields

This form is for Internal Housing use only, if you are not within North Warwickshire Housing please do not complete the form and contact the Counter Fraud Team on 01332 640888

Name of Referring Officer *

Job Title *

Open Housing Case Number

Type of Fraud *

Category *

Details of Tenant

Forename *

Surname *

National Insurance Number

Date of Birth *

First Language

Full Address

Address Line 1 *

Address Line 2 *

Address line 3

Postcode *

Is a fob required to access the front door of the property

Yes

Commencement of Tenancy

Other occupants listed in household

Please detail and list Names, Relationship to the tenant and Date of Births here

Housing Benefits in payment?

Is the customer getting help with rent payments *

Housing Benefit

No Benefits

Unknown

Details of the fraud

Date suspicion arose

Details

Source, where has the intel come from

Please provide Name, address and any contact information

What action has already been done?

Further information

Any PV or Warnings

Please indicate if you are aware of any warning indicators or risks known to the person or the address that we need to be aware of *

If you stated YES! please provide details here

Uploading Files

Please upload any supporting documents and evidence below, if you are unable to please email the Counter Fraud Team on Fraud@derby.gov.uk.
Once you have submitted the form, this should be emailed to you, so you can add to the Tenancy Correspondence file, if you do not get this please email fraud@derby.gov.uk and this can be sent to you.

File Upload

Send us any evidence you may have to support your referral.

Choose file to upload (Maximum file size allowed 100 MB)

Enter valid email address where the referral receipt and form full copy will be send