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1. Your occupancy

   1. Account Number:
   2. The date when you became the sole occupier:*
   3. Is this the date you moved into the property?

      1. Yes
      2. No
2. Other occupants

   1. Have you become the only occupier as someone has moved out?

      1. Yes
      2. No
   2. Leaving occupant 1

      1. Name:
      2. Forwarding address:
   3. Leaving occupant 2

      1. Name:
      2. Forwarding address:
   4. Reason for leaving:
   5. Status in your household: (i.e. lodger, partner)
3. Other circumstances

   1. Are you applying for the discount due to any other changes in circumstances?

      1. Yes
      2. No
   2. Details
4. Young adults

   1. Are there any members of the household aged 16 or 17?

      1. Yes
      2. No
   2. If yes, please specify their full name and their date of birth
   3. Young adult 1

      1. Full Name:
      2. Date of birth:
   4. Young adult 2

      1. Full Name:
      2. Date of birth:
   5. Young adult 3

      1. Full Name:
      2. Date of birth:
5. Your Details

   1. Title: Please select Mr Mrs Miss Ms Dr Other
   2. Forename:*
   3. Initials:
   4. Surname:*
   5. Company name: (if applicable)
   6. Home Phone:
   7. Work Phone:
   8. Mobile Phone:
   9. Email Address:*
   10. House Number/Name:
   11. Street Name:*
   12. Village/Locality:
   13. Town/City:*
   14. County:
   15. Country:
   16. Post Code:*
6. Validation

   1. Label

We aim to comply with the General Data Protection Regulation at all times.  To see how we handle personal information, please ensure that you have read our Privacy Notice.

If you are not satisfied with the way your personal information is handled please contact the Data Protection Officer at foi@sedgemoor.gov.uk

Full Details for Revenues Enquiries