Application*for*Reduction*in*Council*Tax!-!Severely*
Mentally*Impaired.!
A!person!is!severely!mentally!impaired!if!they!have!a!severe!impairment!of!intelligence!and!social!
functioning!which!appears!to!be!permanent.!They!must!be!entitled!to!one!of!the!following;!!
Attendance!Allowance!or!Constant!Attendance!Allowance!!
The!Care!component!of!Disability!Living!Allowance!(DLA)!!
The!daily!living!component!of!Personal!Independence!payments!(PIP)!!
Severe!Disablement!Allowance!!
Incapacity!benefit!or!Income!support!with!a!disability!premium!
Working!Tax!Credit!with!a!Disability!Premium!
Universal!Credit!if!it!includes!an!element!for!limited!capacity!for!work!related!activity!
Pension!Credit!or!disablement!pension!where!constant!care!is!needed!
Armed!Forces!Independence!Payment.!!!
Please*save*the*document*to*your*device*before*completion.**You*can*then*return*the*Form*as*
an*attachment.!
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Council!Tax!Account!Number!
!
!
!
Address!of!Property!
!
!
!
Number!of!people!aged!18!and!
above!living!in!the!property!
!
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Name!of!person!to!be!
disregarded!
!
!
Their!Date!of!Birth!
!
!
!
What!State!Benefit!is!received!by!
the!person!to!be!disregarded?!
(See!Above)!
!
What!date!did!the!Benefit!start?!
!
!!
!
Does!this!person!have!a!Learning!
Disability?!
!
Yes! No!
If!Yes,!are!they!known!to!
Enfield’s!Learning!Disability!
team?!
Yes! No!
Name!and!address!of!the!Medical!
Practitioner!with!knowledge!of!
this!person’s!condition.!
!
Confirmation!of!the!person’s!
condition!must!be!provided.!!
!
Name!!
Address!
Declaration*
!
I!confirm!that!the!information!is!
correct!to!the!best!of!my!
knowledge.!!
!
Name!
Date!
Phone!number!!
!
!
Email!address!
!
!
!