Revenues Services, Bromsgrove District Council, Parkside, Market Street, Bromsgrove. B61 8DA
Email Address: council.tax@bromsgrove.gov.uk 
Telephone Direct Line (01527) 881671 

Date Issued:  16 October 2017

         COUNCIL TAX CLAIM FORM FOR A CARER’S DISREGARD

ACCOUNT REFERENCE (IF KNOWN) :		

Applicant’s Full Name 	
Address of Property:  	
								Post Code:  	
Email Address:								
Daytime Tel No :						Mobile Tel No:	

A person will be disregarded for the purposes of Council Tax on a particular day of he/she is engaged in 
providing care or support and the prescribed conditions are fulfilled.  

Are you a relevant body (See explanatory notes overleaf) to provide care or support.  If yes complete 
Section 2 if not complete section 1.

	SECTION 1 – CARER 	
		
1.	Full name of person being cared for:  						
		
2.	Is the carer caring for their husband or wife, or someone with whom they live	Yes		No			
	as husband or wife?						
		
3.	Is the carer caring for their child who is under the aged of 18yrs?	Yes		No			
							
4.	Does the carer live in your house?	Yes		No			
							
5.	Is the person you are providing care for in receipt of any of the following?						
	(Please provide proof of any allowances received)						
	    a)  higher rate attendance allowance 	Yes		No			
							
	    b)  higher rate of the care component of a disability living allowance	Yes		No			
							
	    c)  the appropriately increased rate of disabled pension	Yes		No			

	    d)  an increase in a constant attendance allowance	Yes		No			

6.	How many hours per week on average do you provide care for?						

	SECTION 2 – CAREWORKER 	
		
1.	Please state the name of the person you provide care for:						
							
2.	Please state which organisation employs you to provide care/support:						
							
3.	Please state where you live when providing care/support: 						

4.	Please state how many hours per week you provide care/support for:						
							
5.	Please state how much remuneration you receive weekly for providing care:						

	Declaration 						
	I declare that the information provided is correct to the best of my knowledge.		
	Signature :		              Date:				
							
	Full Name :						
	If someone is applying for you they should sign below.				
	Signature:		              Date:				
							
	Full Name:						

EXPLANATORY NOTES
A relevant body means:-a Local Authority within the meaning of the Local Government Act 1972.
•	the Common Council of the City of London.
•	the Council of the Isles of Scilly.
•	the Crown.
•	a body established for charitable purposes only.
A person providing care will not be disregarded for Council Tax if he/she is caring for a disqualified 
Relative.  A person is a disqualified relative of another if:-
•	he/she is the spouse of the another or they live together as husband and wife, or
  he/she is the parent of a child who is under the age of 18 years old.	
Payment of Council Tax must be made as shown on your bill until this application has been dealt with and you have been notified officially