People with severe mental impairment
Exemption form

Please complete the details below. Print and sign the form
and post it back to us with the necessary evidence.
don't forget tofill inprintsignevidencepost
1. Details of person liable to pay Council Tax

Title
First Name(s)

Last Name

2. Details of person with severe mental impairment (if different)

Title
First Name(s)

Last Name

3. Address
Address of property
Postcode
Telephone
E-mail
4. Other details
Council Tax reference (if known)

Benefit Status

In order to obtain a discount, the person with severe mental impairment MUST be in receipt of one of the following benefits. Please tick which applies:
Incapacity Benefit
Attendance Allowance
The Care component of the Disability Living Allowance payable at either the middle or the highest rate
An increase in the rate of his/her disablement pension due to the need for constant attendance
Severe Disablement Allowance
Disabled Person's Tax Credit (formerly Disability Working Allowance)
Unemployability Supplement

Income Support Disability Premium
Constant Attendance or Employability Allowance under:- (1) Article 14 or Article 18 respectively of the Personal Injuries (Civilians) Scheme 1983: or

(2) Article 14 or Article 18 respectively of the Naval, Military and Air Force etc (Disablement and Death) Service Pensions Order 1983
Evidence Required: As proof of any of the above benefits a photocopy of the inside of the benefit book or a photocopy of the letter from the Benefits Agency will be sufficient.
Medical Practitioner's Name
Medical Practitioner's Address
 
I authorise Greenwich Council to approach the above named person's Medical Practitioner with a view to obtaining the required certificate.

Signed

 

 
Name in full
Relationship to mentally impaired person
A copy of the Medical Practitioner's certificate will be sent to you in due course together with notification of the decision whether or not the has been granted.

Sign and post this form
with the evidence required, to:

 Council Tax Section,
Greenwich Council, PO Box 4794,
London SE7 7DJ

Please note that making a false declaration will lead to the imposition of a fine of £50, rising to £200 for a further false declaration (in accordance with schedule 3 of the Local Government Finance Act 1992).

If your circumstances change you must notify the council immediately.