Student Accommodation Exemption Application Form - Council Tax (Page 2 of 2) in pdf

Student Accommodation Exemption Application Form - Council Tax Page 2

Section 1 continued

Full name of

Dates of

Establishment where

Course dates and

all occupiers

tenancy

student is studying

enrolment numbers

If there is not enough room on this form, please give further details on a separate piece of paper and attach it to this

form.

Section 2

Owner’s or Managing Agent’s Full Name

Address

Postcode

Section 3 – Declaration

I declare that the information given on this form is true and complete to the best of my

knowledge and belief. I understand that the council may check this information as necessary

with various external agencies and other council departments. I am also aware that I am

required to notify the Council in writing of any change in circumstance which may affect my

claim

HAVE YOU REMEMBERED TO INCLUDE YOUR STUDENT CERTIFICATE?

Signature

Date

Please note, a person who makes a false claim may have a penalty of up to £350 imposed

Once completed please return this form to us at any

DATA PROTECTION

of our Customer Service Centres or Information Points.

The information you have been asked to

Alternatively you can send it to

provide may be recorded on computer

Freepost RSJC - KKBE - ABXZ,

and is subject to the Data Protection Act,

Revenues and Benefits,

1998.

Hull City Council

Some information may be disclosed to

P.O. Box 15,

Housing Benefit offices and other

Hull.

departments of the council.

HU1 2AB

CSCCSTR – Student Application Exemption application

Student Accommodation Exemption Application Form - Council Tax Page 2