Disability Reduction Claim Form

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Disability Reduction Claim Form

Council Tax

Please read the guidance notes before completing the form.

Mandatory fields are identified with an asterisk (*).

A. Application Details (only people who are liable to pay Council Tax can apply for a reduction)

First Name:
Surname:	*
Address:	Please enter details ...
Town:
Daytime Telephone Number:

B. Disabled Person (the Disabled Person must be living in the dwelling for which the reduction is being sought)

First Name:
Surname:
Address Of Property (If different from above)	Please enter details ...

C. Grounds For Application (please tick the appropriate box(es))

Have permanent adaptations been made to the property to meet the needs of the qualifying individual?
Has a second bathroom or kitchen been installed to meet the needs of the qualifying individual?
Is there sufficient floor space for the indoor use of a wheelchair on a permanent basis by the qualifying individual?

D. Declaration

The information given on this form is correct. I undertake to notify you immediately if I believe that I am no longer eligible for a redution granted in respect of this application.