If you don’t have one, leave this blank.
Full name of disabled person
Date moved in
Date of disablement
Name of disabled person’s doctor
Surgery address 1
Surgery address 2
Select which qualifying criteria apply to you.
Is there a room used mainly for the needs of the disabled person?
Is there a second bathroom or second kitchen used mainly for the needs of the disabled person?
Does the disabled person need to use a wheelchair in the home?
By submitting this form you declare the information given above is correct and that you may be liable to a penalty of £70 if you knowingly provide false information.
If you meet the above criteria your discount will be automatically applied and a new council tax bill issued. A review date will be scheduled and if it is found that, following this review, that you do not meet the criteria, your discount will be withdrawn any discount given will have to be repaid to North Somerset Council.