Residential care workers discount form

1. This form is to be used to be considered for a discount on your Council Tax if you are a residential care worker.
  
  For more information on how to be considered for a discount and the criteria required please visit Residential Care Workers page.
2. Part 1 - Applicant (this form must be completed by the person who is liable to pay the Council Tax)
  1. First name (optional)
  2. Applicants name
  3. Address line 1
  4. Address line 2 (optional)
  5. Town/city
  6. Postcode
  7. Telephone number (optional)
  8. Mobile number (optional)
  9. Email address (optional)
  10. Part 2 - Residential Care Workers name (The dwelling must be his/her sole/main residence)
    
    Name of Residential Care home (optional)
    
    Address of Care home (optional)
    
    Address line 2 (optional)
    
    Town/city (optional)
    
    Postcode (optional)
    
    Part 3 - Residents of the property
    
    How many residents of the property will be aged 18 or over by next April?
    
    Part 4 - Certificate to be completed by Employer
    
    Please enter below the information requested including details of the last four weeks or two months earnings
    
    Full name of employer (optional)
    
    Residential Address of employee (optional)
    
    Week or month 1 gross pay ended earnings (optional)
    
    Week or month 2 gross pay ended earnings (optional)
    
    Week 3 gross pay ended earnings (optional)
    
    Week 4 gross pay ended earnings (optional)
    
    Normal weekly hours worked (optional)
    
    Date employment commenced (optional)
    
    Normal weekly hours worked (optional)
    
    Does the above reside in premises provided by you? (optional)
    
    Yes
    
    No
    
    Name of employer (optional)
    
    Address of employer (optional)
    
    Address of employer (optional)
    
    Town / City (optional)
    
    Postcode (optional)
    
    Part 5 - Declaration to be completed by charity introducing care worker to care recipient
    
    Name of Care Worker (optional)
    
    Last name (optional)
    
    Name of Charity (optional)
    
    Address of Charity (optional)
    
    Address of Charity (optional)
    
    Town/city (optional)
    
    Postcode of Charity (optional)
    
    Part 6 - Declaration
    
    I declare that the information given in this form is to the best of my knowledge, accurate and complete. I will notify you should any of the information on this form changes, within 21 days of the change occurring, otherwise I may incur a penalty.
    
    Warning!
    
    If you give false information you could be prosecuted.
    
    Preston City Council will use your information in a manner compatible with the General Data Protection Regulation (GDPR).
    
    Any disclosures or sharing of information will only take place where required or permitted by law. For further information please see our privacy notice .

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Residential care workers discount form

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