Council Tax - Single Persons Discount Review Form

Your Details

Title: *

Forename: *

Surname: *

Council Tax Account Ref: *

Telephone Number:

Email address:

House name/number:

Postcode:

Address: *
You can enter the house name/number and postcode above to populate this field.

Are you the sole occupier aged over 18 living at the address? *

Yes
No

Details of Change

Date of Change: *

People moving in

Title: *

Forename:

Surname: *

Relationship:

Previous Address

House name/number:

Postcode:

Address:
You can enter the house name/number and postcode above to populate this field.

Another Person Moving In? *

Previous Address

House name/number:

Postcode:

Address:
You can enter the house name/number and postcode above to populate this field.

Previous Address

House name/number:

Postcode:

Address:
You can enter the house name/number and postcode above to populate this field.

Completing the form

Are you completing this form yourself?

Yes
No

Details of person completing form

Do you have a CSA reference? *

Yes
No

Title: *

Forename: *

Surname: *

Phone Number:

Email:

House name/number:

Postcode:

Address:
You can enter the house name/number and postcode above to populate this field.

Relationship to applicant: *

Declaration

I declare that the information provided is true and accurate to the best of my knowledge. If the information is incorrect or inaccurate the council may take legal action which could result in prosecution.

I understand

• That a change in circumstances should be notified to the council within 21 days. Failure to report changes may result in legal action against me.

• That the information included on the review form may be checked and I may be asked to provide supporting evidence.

• And agree that the council will use the information provided to process the review form and I authorise the council to check any other information held about me.

We are under a legal obligation to share personal information with Government departments. To see how we hold your data and who we share it with, please visit Revenues and Benefits Privacy Notice

Do you accept these terms and conditions