Third Party Authorisation Form (v3.0) Page 1 of 3
Third Party Authorisation Form
In order to safeguard your data and full 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
Is this address to be used for correspondence? Yes No
If no, please provide a correspondence address:
Until further notied 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 conrm 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 conrm that I am the named ratepayer for the above account and agree to this authorisation.
Name (in BLOCK CAPITALS)
LPS Privacy Notice: www.finance-ni.gov.uk/publications/lps-privacy-notice