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Hospital / receiving care discount form

Council tax living in a care home exemption form

If you've received a council tax bill that's the responsibility of someone who now permanently lives in a care home or hospital, please complete this form as soon as possible.

A. Claimant and property details

Full name of claimant

Missing or incorrect value

Full address of property

Missing or incorrect value

Council tax account number (shown on bill)

Missing or incorrect value

Working Group No.

Are there any other adults over 18 living at the property?

If yes, please provide their name(s)

If no, is the property now empty?

Date claimant left

Missing or incorrect value

Address where the claimant now resides

Missing or incorrect value

B. Declaration

Name of person sending this email

Missing or incorrect value

Address of person sending this email

Missing or incorrect value

Email address

Relationship to the claimant

Missing or incorrect value

When the Council receives this emailed form, it will be treated as a declaration from the sender that the information given is correct and that the Council will be notified immediately of any change in circumstances.