Disabled Band Reduction Review Application

Council Tax Account numberRequired

Name of disabled person(s)Required

To continue to qualify for the reduction, at least one of the following conditions must be met

Please answer Yes or No to the following statements

A room which is predominately used by and required for meeting the needs of the disabled person(s)Required

A second bathroom and/or second kitchen required for meeting the needs of the disabled person(s)Required

A wheelchair used indoors by the disabled person(s)Required

There has been a change in my circumstances affecting my entitlement to this reduction. The changes are:

Exact date of change

DECLARATION

I declare that my circumstances and the information provided above is to the best of my knowledge true and accurate. I understand that supplying false information will result in the reduction being removed, also that if my circumstances change I will immediately notify Dacorum Borough Council.

Name

Daytime telephone number

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DECLARATION