This form has a maximum of 7 pages
Completing this form
Before completing this form, please refer to the guidance on the Severe Mental Impairment Exemption for council tax page.
Please be aware that our system will 'time out' after 10 minutes. As part of your application you’ll need to upload scanned copies of ‘evidence of entitlement’ to various benefits - please note that this form will only accept uploaded documents in either .pdf or .jpg formats.
We strongly suggest that you prepare such documents before starting this form so that you can locate them easily, and within the time limit. It is not possible to save partially completed forms, nor to retrieve information if the time out period is reached.
Your privacy and security
Please do not use this form to send anything of a confidential nature, for example, your credit card or bank details.
We do not rent, sell or trade your personal information; please see our privacy statement.
Any personal information you provide will be kept in accordance with the Data Protection Act 1998. If we receive an enquiry under the Freedom of Information Act, we will only disclose information we have been provided with in accordance with the relevant legislation.
West Offices, Station Rise, York, YO1 6GA
Telephone: 01904 551558