Form Runner

Your browser does not appear to support JavaScript. You may want to try one of the following:

Turn on JavaScript in your browser if it supports it.
Use a browser that supports JavaScript.
Try a JavaScript-free version of this page, if made available by the application author.

There's a problem with this form.

Sorry, something's gone wrong with this form.

This may have happened because the form was open for a long time.

We haven't saved any personal information you entered. We do this for your security.

Try loading the form again:

in Chrome, Safari or Internet Explorer: hold down the Ctrl key (Command on iOS machines) and click the reload button on the toolbar
in Firefox: hold down the shift key and click the reload button on the toolbar

If this doesn't work, please use the website feedback form to tell us there's a problem.

Show details

Hide details

Help

$xforms-template-label$$xforms-template-help$$xforms-template-hint$$xforms-template-label$$xforms-template-help$$xforms-template-hint$

Go to Content

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, you should complete this form as soon as possible.

A. Claimant and property details

Full name of claimantMissing or incorrect value

Full address of propertyMissing 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 residesMissing or incorrect value

B. Declaration

Name of person sending this emailMissing or incorrect value

Address of person sending this emailMissing or incorrect value

Email address

Relationship to the claimantMissing 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.

Read our privacy statement and our council tax privacy notice to see what we do with your personal information.

Council tax living in a care home exemption formEditIncomplete

1 of 1

9d05f98491d2812d4d4bb6d2c17cde8c2dd1b89f

Confirm

Found draft

Found drafts

Existing form data found

Form Submitted

Review Form Validation Messages

Unable to complete action

Confirmation

Insert Above
Insert Below
Move Up
Move Down
Remove Line