Class E - moved to a care home or hospital to receive care application form

Council Tax Account Reference: *

Name: *

Surname: *

Address: *

Postcode: *

Phone number: *

Email address: *

Name of person who has moved out of the residential address above to receive care: *

Date the person left the property to go into care: *

Who owns the property that will become empty? *

Is this care placement permanent? *

No - it is not permanent
Yes - it is permanent

If temporary, when are they expected to return to property?

If you answer no to this question because the care placement is temporary, you will NOT qualify for an exemption

Will the property remain empty? *

No, the property will not remain empty
Yes, the property will remain empty

Will the property be occupied by anyone over the age of 18? *

Yes, it will be occupied by someone over the age of 18
No, it will not be occupied by anyone over the age of 18

Please provide the name and address of the person(s) who will be occupying the property.