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Are you related to or do you have a close personal relationship
with any Councillor or employee of Suffolk County Council?
If yes, please state their name and position:
n n
Yes No
Bank Reference:
Name, contact name and address of your bank:
Do you give your consent for a Banker’s reference to be taken up?
You will be responsible for any costs incurred when the Council seeks a banker’s reference.
Declaration
I confirm that the information I have given on this form is correct and complete and that misleading
statements may be sufficient for any agreements to be cancelled. I understand that, in the event of being
shortlisted for interview, I will be required to complete a confidential declaration in respect to my health.
I understand that if I knowingly withhold or supply incorrect information, my application may be
cancelled and any tenancy promised or already granted may be withdrawn.
Submission
When completed this application form should be forwarded, along with the projected budgets and
cashflow forms (where applicable) to:
• Matthew Lee, Corporate Property Advisor (County Farms), Endeavour House, 8 Russell Road,
Ipswich, Suffolk IP1 2BXTel: 01473 264109 or by e-mail to: CountyFarms@Suffolk.gov.uk
n n
Yes No
Applicant’s signature:
Date:
