Disabled banding review application


Title

First name

Last name

Address 1

Address 2

Town

Postcode

Email address

Telephone number

Reference or council tax number

If you don’t have one, leave this blank.

Disabled person information

Full name of disabled person

Date moved in 

Date of disablement 

Doctor information

Name of disabled person’s doctor

Surgery address 1

Surgery address 2

Town

Postcode

Select which qualifying criteria apply to you.

Is there a room used mainly for the needs of the disabled person?
 yes   no

Is there a second bathroom or second kitchen used mainly for the needs of the disabled person?
 yes   no

Does the disabled person need to use a wheelchair in the home?
 yes   no

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be scheduled and if it is found that, following this review, that you do not meet the criteria, your discount will be withdrawn any discount given will have to be repaid to North Somerset Council.