Moving into a nursing or care home discount form

1. This form is to be used to be considered for a Council Tax discount if you or someone living in your property is moving into a Hospital, Nursing or Care Home.
  
  For more information on moving into a Nursing or Care Home discounts and what criteria is required please visit Moving into a Nursing or Care Home page.
  
  Please Note This discount is for persons who are permanently resident in a hospital, Nursing Home or Residential Care.
2. Part 1 - Applicant (this form must be completed by the person who is liable to pay the Council Tax)
  1. Council Tax Reference Number (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)
3. Part 2 - Nursing/Care Home details - The dwelling must be his/her sole or main residence
  1. Name of Nursing home or Care home (optional)
  2. Address of Nursing home or Care home (optional)
  3. Address of Nursing home or Care home (optional)
  4. Town/city (optional)
  5. Postcode (optional)
  6. Part 3 - Residents of the property
    
    How many residents of the property will be aged 18 or over by next April? (optional)
    
    Enter the full name of the person moving into a home?
    
    What type of home will the person be moving to?
    
    Care Home
    
    Nursing Home
    
    Mental Nursing Home
    
    Enter the date that the person became resident in the home
    
    Part 4 - 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. *
    
    Yes
    
    No
    
    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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Moving into a nursing or care home discount form