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Disablement Relief Application


If there is a disabled person living at the property, use this form to apply for a disablement relief.

 


Your Details


Title:

 

First Names:  

 

Surname:


Address:


Council Tax Reference Number:  

 

Daytime Telephone Number:

 

Your E-mail Address:

 


Disabled Person


Title:

 

First Names:  

 

Surname:


Address of Disabled Person: (if different from above)


Nature of Disability:  

 


Please indicate which of the following apply:


   
Is there a room, other than a bathroom, kitchen or lavatory, which is predominantly used by and required for meeting the needs of the disabled person?

 
Is there a second bathroom or kitchen required for meeting the needs of the disabled person?

 
Does the disabled person use a wheelchair indoors?

 

   

 

It will be necessary for an officer to visit the disabled person at their property, you will be contacted in due course to arrange a convenient date and time.