ࡱ> Y[X #bjbj 7H}&&$$$$$$$$8$L%L$|/d%@%%%%&&&.......$1H4t!/$&&&&&!/$$%%6/7)7)7)&$%$%.7)&.7)7)g..%z6#%'Z..L/0|/.4(4$.4$.D&&7)&&&&&!/!/7)&&&|/&&&&4&&&&&&&&&& F#: MERGEFIELD DATA "\\\\ABCNT5002\\FINANCE\\MASTERFILE\\CTDocuments\\Data Sources\\Disabled Persons Reduction Data1.doc" INCLUDEPICTURE "I:\\MASTERFILE\\Ctax Comino Templates\\letterhead logo.bmp" \d \x \y MERGEFIELD d Name___________________________________________ Subject Address___________________________________ ________________________________________________ ________________________________________________ Council Tax Reference Number_______________________ COUNCIL TAX - DISABLED PERSONS REDUCTION The Council Tax (Reductions for Disabilities) (Scotland) Regulations 1992 A. EXPLANATORY NOTE - TO QUALIFY FOR A REDUCTION IN THE AMOUNT PAYABLE, YOU MUST SATISFY THE FOLLOWING REQUIREMENTS: 1) You, or a member of your household, must be a disabled person within the meaning of the above Regulations, and you must be liable to pay Council Tax in respect of that household. Section C of this form is used to identify whether such disability exists. 2) Facilities required for meeting the needs of the disabled person, must exist within the property which must be the sole or main residence of the disabled person. Section D of this form is used to identify whether such facilities exist. B. INFORMATION ABOUT THE APPLICANT: 1) ARE YOU: (i) AN OWNER/OCCUPIER? _________________________ YES/NO (ii) A TENANT? _____________________________________ YES/NO 2) IF YOU ARE A TENANT, TO WHOM DO YOU PAY YOUR RENT? Please provide name and address of your landlord. Name: ___________________________________________________________________________________  Address: ___________________________________________________________________________________ ___________________________________________________________________________________ PLEASE COMPLETE NEXT 2 PAGES ACCORDINGLY Reference Number:___________________________ C. INFORMATION ABOUT THE DISABLED PERSON: NAME OF DISABLED PERSON_______________________________________________________________ 2) PLEASE GIVE A DESCRIPTION OF THE NATURE OF THE DISABILITY: __________________________________________________________________________________________ __________________________________________________________________________________________ ______________________________________________________________________________ D. INFORMATION ABOUT FACILITIES REQUIRED FOR MEETING THE NEEDS OF THE DISABLED PERSON: DO ANY OF THE FOLLOWING EXIST? IF YES, GIVE DATE OF INSTALLATION 1) AN ADDITIONAL BATHROOM, REQUIRED FOR MEETING THE DISABLED PERSONS NEEDS? . YES/NO * ____/____/____ 2) AN ADDITIONAL KITCHEN, REQUIRED FOR MEETING THE DISABLED PERSONS NEEDS? . YES/NO * ____/____/____ 3) THE USE OF A WHEELCHAIR, BY THE DISABLED PERSON, INSIDE THE HOUSE? YES/NO * ____/____/____ 4) A ROOM, OTHER THAN A BATHROOM, KITCHEN, OR LAVATORY, WHICH IS USED PREDOMINANTLY (WHETHER FOR PROVIDING THERAPY OR OTHERWISE) BY THE DISABLED PERSON, AND REQUIRED FOR MEETING THEIR NEEDS? . YES/NO * ____/____/____ (IF THE ANSWER TO QUESTION D.4) IS NO, GO TO SECTION F) * Delete as appropriate NOTE: If a room is predominantly used on a daily or weekly basis for physiotherapy, a letter is required from the physiotherapist confirming that the applicant is receiving treatment, the treatment is being carried out in the property and whether the treatment is short or long term. E. DETAILS OF ROOM USED BY DISABLED PERSON PLEASE GIVE DETAILS OF THE TYPE OF ROOM, AND ITS USE: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Reference Number:___________________________ F. DOCTORS CERTIFICATE: The information detailed in Section C is/is not an accurate description of the disability suffered by the disabled person mentioned on this form and in my opinion the facilities listed in Section D are/are not required for meeting the needs of the disabled person mentioned, taking account of the nature and extent of the disability. DOCTORS SIGNATURE __________________________________ DATE _______________________ SURGERY ADDRESS ___________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Doctors Stamp If you are unable to get your doctor to complete the certificate above, please provide the name and address of your doctor and the Council will request Certification direct. Please note that any charges arising from this will remain the responsibility of the Council Tax payer. DOCTORS NAME: _______________________________________________________ SURGERY ADDRESS: _______________________________________________________ _______________________________________________________ G. APPLICANTS CERTIFICATE: I declare that the information given on this application form is correct and I undertake to notify you immediately if the disabled person ceases to reside in the house, ceases to use the facilities, or the facilities cease to exist. SIGNATURE: _________________________________________ DATE: __________________________ CONTACT NUMBER: ____________________________ EMAIL: _______________________________ Data Protection Fair Processing Notice: ֱ, will primarily use the information you have supplied on this form for the collection and administration of Council Tax. You have a statutory duty to provide the information. The level of Council Tax charged must be accurate and the Council will use information from other agencies to check liability for Council Tax and minimise fraud and error where it is necessary to do so. We share information with other sections of the Council and other organisations external to the Council where it is lawful to do so. A full privacy notice is available at /privacy/council-tax .You have a right to apply for a copy of the information we hold about you, and to have any inaccuracies corrected. Should you wish to exercise this right, your request must be made in writing to the Data Protection Officer, ֱ & Bute Council, Kilmory, Lochgilphead, PA31 8RT, mail HYPERLINK "mailto:iain.jackson@argyll-bute.gov.uk"iain.jackson@argyll-bute.gov.uk or telephone 01546 604188. 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