Property details Council tax account number: * Address Property number/name: * Street/road name: * Town/city: County: Postcode: * Occupants Full name of disabled person: * Is the property still occupied by a disabled person? * Yes No Please read the Eligibility for disabled band relief Date when disabled person left the property: Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20152016201720182019 Details of person completing the form: Title: * - Select -MrMissMrsDrMsOtherRev First name: * Last name: Telephone: Email: * Declaration I confirm that the information provided is a true and accurate statement of my current circumstances. * Yes No This authority is under a duty to protect the public funds it administers, and to this end may use the information you have provided on this form for the prevention and detection of fraud. It may also share this information with other bodies responsible for auditing or administering public funds for these purposes.For further information, see www.broxbourne.gov.uk/resident/privacy-policy or contact the Council’s Data Protection Officer on 01992 785577. E-communications Please tick the box to receive relevant e-communications from the Council E-communications are emails that provide information about Council services and events. All information supplied will be processed and held in accordance with Data Protection regulations.