Refund application

Please complete the application in full

Please complete and submit

Council Tax Account Reference *

Your Full Name *

Your address including post code *

Your contact telephone number *

Your email address

Name and full address of your bank/building society *

Sort Code *

Bank or building society account number *

Name of account holder *

Please tick to acknowledge agreement to the declaration below *

Declaration

I declare that the information given above is to the best of my knowledge, true and accurate and the Council may verify this from the appropriate sources. I undertake to notify the council as soon as these circumstances change, and I acknowledge that failure to do so could result in a penalty being imposed. I understand that the information given on this form may be matched against data held by other departments and local authorities.

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