Fillable Rate Account; Third Party Authorisation Form (Northern Ireland Public Sector)

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Rate Account; Third Party Authorisation Form (Northern Ireland Public Sector)

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Third Party Authorisation Form (v3.0) Page 1 of 3
Rate Account;
Third Party Authorisation Form
In order to safeguard your data and full our obligations under the Data Protection Act, we will
only enter into a discussion about your rate account with you or with a third party you nominate to act
on your behalf. You can use this form to authorise a third party to act on your behalf, or to update or
remove authorised third parties.
SECTION 1 – RATEPAYER DETAILS
Please provide details relating to the property in question:
Name on Rate Account
Occupancy ID Account ID Ratepayer ID
Property Address
Postcode
Contact Number
Is this address to be used for correspondence? Yes No
If no, please provide a correspondence address:
Correspondence Address
Until further notied by me in writing, I give permission and authorise Land & Property Services
to release and discuss any relevant details of my rate account with the individuals authorised in
Section 2 and hereby conrm that they have the authority to act on my behalf.
Please provide your name and signature to confirm that you are the ratepayer on this account
and agree to the above authorisation.
I conrm that I am the named ratepayer for the above account and agree to this authorisation.
Name (in BLOCK CAPITALS)
Signed Date
DD/MM/YYYY
Postcode
LPS Privacy Notice: www.finance-ni.gov.uk/publications/lps-privacy-notice
Third Party Authorisation Form (v3.0) Page 2 of 3
SECTION 2 – THIRD PARTY AUTHORISATION
Please provide details of the authorised person and the changes that you wish to make:
I wish to:
Add an authorised person Replace an authorised person Remove an authorised person
Surname (of authorised person) First name(s) (of authorised person)
Property Address
Postcode
Contact Number (of the authorised person) Relationship to ratepayer
I wish to:
Add an authorised person Replace an authorised person Remove an authorised person
Surname (of authorised person) First name(s) (of authorised person)
Property Address
Postcode
Contact Number (of the authorised person) Relationship to ratepayer
Once you have completed and signed this form please send it to your local Land & Property Services
Office. You can find your local office address on page 3 of this form.
For further information relating to this form: Dial 0300 200 7801 (Calls charged at Local rate)
If outside NI, dial +44 28 9049 5794. Text Relay 18001 0300 200 7801
Rate Account;
Third Party Authorisation Form
Third Party Authorisation Form (v3.0) Page 3 of 3
NORTH EASTERN REGIONAL RATING OFFICE
Ballymena office
for council districts
Antrim and
Newtownabbey, Mid and
East Antrim
Academy House
121A Broughshane Street
Town Parks
BALLYMENA
BT43 6HY
Email: northeastern.rating@lpsni.gov.uk
BELFAST REGIONAL RATING OFFICE
Belfast office
for council districts
Belfast, Lisburn and
Castlereagh, Ards and
North Down
Lanyon Plaza
7 Lanyon Place
Town Parks
BELFAST
BT1 3LP
Email: eastern.rating@lpsni.gov.uk
Email: belfast.rating@lpsni.gov.uk (Belfast,
Lisburn & Castlereagh councils)
NORTH WESTERN REGIONAL RATING OFFICE
Londonderry office
for council districts
Causeway Coast and
Glens, Derry City &
Strabane
Waterside House
75 Duke Street
Gobnascale
LONDONDERRY
BT47 1FP
Email: northwestern.rating@lpsni.gov.uk
SOUTHERN REGIONAL RATING OFFICE
Craigavon office
for council districts
Armagh City, Banbridge &
Craig
avon, Newry, Mourne
and Down
Marlborough House
Central Way
Tamnaglassan
CRAIGAVON
BT64 1AD
Email: southern.rating@lpsni.gov.uk
SOUTH WESTERN REGIONAL RATING OFFICE
Omagh office
for council districts Mid
Ulster, Fermanagh and
Omagh
Boaz House
19 Scarffe’s Entry
Dergmoney Lower
OMAGH
BT78 1JE
Email: southwestern.rating@lpsni.gov.uk
LPS Regional Rating offices are open to the public:
Monday to Thursday 9.30am to 4.30pm and Frid
ay 10.00am to 4.30pm
Once y
ou have completed and signed this form please send it to your local Land & Property Services
Ofce. Identify the correct LPS Regional Rating Office:
Rate Account;
Third Party Authorisation Form
© Crown Copyright 2016
Page 3 of 3
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Rate Account; Third Party Authorisation Form (Northern Ireland Public Sector)

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Completed 3 May 2022

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