Regulation 36 of the Council Tax (Administration & Enforcement) Regulations 1992
You must supply the details requested on this section of the form, otherwise you may incur a Court Fine. If a Court Fine is incurred, your name may be entered on the PUBLIC REGISTER OF JUDGEMENTS, ORDERS AND FINES, which could seriously affect your ability to obtain credit (e.g. bank overdrafts, loans, credit cards, shop/catalogue credit, or a mortgage). |
Personal Details (Section 1) |
| Title: |
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| *First Name: |
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| *Surname: |
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| Daytime Telephone number: |
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| *Address |
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| *Email: |
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| *Confirm
Email: |
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| *Council Tax Reference number |
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Employment |
| *Are you employed: |
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If Yes, please supply - The name and address of your employer:
If No, please go to the next section called Other Income |
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| Works Number / Pay Reference: |
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| Average Net Earnings (take home pay): |
Per |
If an attachment of earnings order is currently in force, please give details: |
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Other Income |
| *Are you receiving Income Support or Jobseeker’s Allowance? |
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If YES - please supply your National Insurance Number |
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| If NO – if you are not employed, or receiving Income Support / Job Seekers Allowance, please give details of how you obtain income (e.g. self-employed, Incapacity Benefit, Investments, Pension) and how much you receive |
£
Per
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| Please supply the names of any other occupiers, over the age of 18, at this address and their relationship to you |
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Financial Details (Section 2)
You are not legally obliged to supply the information below, but it will help
us to agree a reasonable payment arrangement, rather than using other legal means
of collecting the debt. |
| Vehicle Make: |
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| Vehicle Model: |
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| Vehicle Registration Number: |
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| Year of Registration: |
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| Number of adults in property: |
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| Number of children in property: |
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Income |
| This Budget is: |
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| Income: |
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| Partner's Income: |
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| Pension: |
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| Benefits: |
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| Working families tax credit: |
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| Maintenance: |
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| Non-dependants contribution: |
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| Child Benefit: |
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| Other: |
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| Total Income:
£
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Expenditure |
|
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| Total Expenditure:
£
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| Amount Available:
£
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| Offer of payment towards Council Tax arrears: |
£
Per
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| Please enter the code to your right to continue. |
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*
I declare that the information given here is true and correct. I understand that if I do not provide the information, WITHIN 14 DAYS of this request, I may be liable to a COURT FINE OF £500. Also, if I supply false information, I may be liable to a COURT FINE OF £1,000 AND A CRIMINAL RECORD.
*Required fields
All personal details are
held in accordance with the Council’s Data Protection Policy - Privacy Disclaimer |