Property solely occupied by a person who is severely mentally impaired

Property occupied by person(s) who are severely mentally impaired

About your data
We will ask you for information in order to handle your request and we may use it to contact you. Our privacy policy explains how we handle your personal data.
Account holder details
First name
Last name
Address line 1
Address line 2
Town or city
Postcode
Best daytime contact number
Email address
Confirm email address
Account reference
Name of the claimant with a severe mental impairment
Is the claimant the only resident aged 18 or over at the property?Yes No
Including the claimant, how many occupants aged 18 or over reside at the property?
Please supply their names and relationship to the claimant
Name
Relationship
Name
Relationship
The claimant must be in receipt of a qualifying benefit to be entitled to receive this discount/exemption.
To apply for this discount/exemption please:
- download and ask the claimant's doctor to complete the Application for a Severe Mental Impairment Discount or Exemption (opens in a new window)
- once completed, upload this form along with proof of a qualifying benefit below (please note only one file can be uploaded)
- if you are unable to provide both the signed form and proof of benefit in one file, send any remaining documents to us by email to localtax@basingstoke.gov.uk
The application for discount/exemption cannot be considered until the online form, signed doctor's form and proof of qualifying benefit have all been received.
Please upload signed doctor's for and proof of qualifying benefit (as one document)
Upload file
Are you the account holder or completing the form on the claimant's behalf?Account holder Claimant's representative
I would like to receive text alerts to get a reminderYes No
Mobile number
I would like to receive my bill via email. (Please note that once you have opted in, all bills will be sent electronically and not posted)Yes No
By submitting this form you are consenting to receiving text alerts/ebills/information from us. We will not share this information with any third parties. You can change your mind at any time if you no longer want to receive text alerts/ebills/information from us. If you do change your mind, please contact Local Tax by emailing localtax@basingstoke.gov.uk or calling 01256 844844.
Name
Address
Telephone number
Email
Relationship to account holder
To help us avoid abuse of our system, please enter the correct answer to the question below.

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Property solely occupied by person(s) who are severely mentally impaired

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