Zero Occupancy Discount Form Highland Council (Page 2 of 4) in pdf

DECLARATION - ALL APPLICANTS MUST COMPLETE THIS SECTION

Please read this declaration carefully before you sign and date it.

SECTION ONE

Warning: It is an offence to give false information.

If someone has completed this form on your behalf, you must make sure that it has been

read back to you in full and you understand everything before you sign the declaration.



This is my claim for Zero Occupancy Discount;



I declare that the information I have given on this form is correct and complete;



I authorise the Highland Council to check the information I have given and make any necessary enquiries to

verify the information on this form;

I understand that if I give information that is wrong or not complete or fail to report a change which may affect



my discount, I may have to pay a fine of up to £200. I have no objection to the Council inspecting my property.

All persons named on the Council Tax bill/responsible for payment of the Council Tax must sign below

Claimant's signature

Date



_________________________________________________________

_________________

Signature

Date



___________________________________________________________________

_________________

Signature

Date



___________________________________________________________________

_________________

Signature

Date



___________________________________________________________________

_________________

SECTION TWO

his section must be completed if the application form has been filled in by someone else on your behalf.

This includes voluntary organisations, an appointee, relative, friend or representative of the Council.

Please PRINT the name of the person who completed this form



___________________________________________

___________________________________________________________________________________________________

Their address



______________________________________________________________________________________

___________________________________________________________________________________________________

Their telephone number



____________________________________________________________________________

Relationship to any of the persons who have signed the declaration in Section One of this form



_______________

___________________________________________________________________________________________________

Please give the reason why the claimant was unable to complete the form



_________________________________

___________________________________________________________________________________________________

I declare that I have filled in this form for the person(s) named above in accordance with their



instructions and have read this back to them in full before they signed the declaration.

Signature of person completing form

Date

______________________________________

___________________

I declare that the person named in Section Two has completed this form on my behalf and has read it



back to me in full. I confirm that I understand the nature of this application and the details provided

in this form.

Signature of Claimant

Date

_______________________________________________________

___________________

Page Two

Zero Occupancy Discount Form Highland Council Page 2

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