Please supply a daytime telephone number in case we have any questions
Please provide your Council Tax reference number if known. It can be found at the top of your council tax bill in the black box.
(Please read the attached notes at the top of this page before completing this form)
A room (other than a bathroom, kitchen or lavatory) which is mainly used for meeting the needs of the disabled person
A second bathroom or kitchen required for meeting the needs of the disabled person
Sufficient floor space to permit the use of a wheelchair required for meeting the needs of the disabled person within the property
Additional Information – please use this box to provide any other information relevant to your application.
If you have answered Yes to any of the above, please give the date this was first effective from
It may be necessary for an officer from the Council Tax section to inspect the property. Please indicate below by ticking all suitable times when a visit may be made. We will contact you before we visit.
Please tick here if you are sending a doctor's (or other medical professional's) letter by post (Please see note 2 in the attached guidance Application for disablement reduction - notes )
Declaration:
* I certify that the above details are correct. I will notify you if I believe that I no longer quality for a reduction granted in respect of this application.
Declaration not confirmed, please check the declaration field
*Mandatory field