Name ( required )Address ( required )National Insurance Number ( required )Date of birth ( required )Day-select-12345678910111213141516171819202122232425262728293031Month-select-JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYear-select-192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024The undersigned hereby authorise Williamsburgh Housing Association’s Welfare Rights Service to act on my behalf in respect of all Financial, Social Security Matters and any subsequent reconsiderations/appeals. I understand that this may include personal information such as medical and financial income. I also give permission for my representatives to receive the outcome of the request they have made on my behalf, this includes any amounts/refusals of awards and their end/start dates. This can be shared either by phone, e-mail kamila.feddek@williamsburghha.co.uk or in writing to the address supplied above. ( required )Date ( required )Day-select-12345678910111213141516171819202122232425262728293031Month-select-JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYear-select-192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024
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