Wealden Local Plan
Issues, Options and Recommendations
Representation Form
Office use only
Date received:
Rep ID:
Consultee ID:
Agent ID:
Please read the following information carefully before completing this form.
We recommend that you read the ‘Guide to the ‘Wealden Local Plan -Issues,
Options and Recommendations Consultation’ leaflet before completing this form, as
this provides information on the consultation. We also suggest that you use the
Consultation Questions as a reference for the questions asked in the Issues, Options
and Recommendations document. Both the leaflet and question booklet can be
viewed online at www.wealden.gov.uk/wealdenlocalplan.
You can answer up to three questions using this representation form but you may
use multiple copies of ‘Part B’ if you wish to answer more than three. Please ensure
you sign at the end of the form. We also ask that you complete the Equality and
Diversity Form on the last page.
Forms must be returned by 5pm on Monday 14
th
December 2015 either by email to
ldf@wealden.gov.uk or by post to: Planning Policy, Wealden District Council,
Vicarage Lane, Hailsham, BN27 2AX.
Please telephone 01892 602007 or email ldf@wealden.gov.uk if you require further
information or assistance in submitting your representation. If you, or somebody you
know, would like this form in large print, braille, audio tape/CD or in another
language please let us know.
Part A Personal Details
Title
First Name
Last Name
Job Title and
Organisation (where
relevant)
Address
Email Address:
Telephone Number
If on behalf of a
company, please state:
Wealden Local Plan
Issues, Options and Recommendations
Representation Form
Office use only
Date received:
Rep ID:
Consultee ID:
Agent ID:
Part B - Representation on the Issues, Options and Recommendations
consultation document
1. Question (Please add a reference e.g. Question 1)
Response to question: (Please tick as applicable)
Agree
Disagree
Please give reasons for your answer, using additional sheets if necessary:
Wealden Local Plan
Issues, Options and Recommendations
Representation Form
Office use only
Date received:
Rep ID:
Consultee ID:
Agent ID:
2. Question (Please add a reference e.g. Question 1)
Response to question: (Please tick as applicable)
Agree
Disagree
Please give reasons for your answer, using additional sheets if necessary
Wealden Local Plan
Issues, Options and Recommendations
Representation Form
Office use only
Date received:
Rep ID:
Consultee ID:
Agent ID:
3. Question (Please add a reference e.g. Question 1)
Response to question: (Please tick as applicable)
Agree
Disagree
Please give reasons for your answer, using additional sheets if necessary
Wealden Local Plan
Issues, Options and Recommendations
Representation Form
Office use only
Date received:
Rep ID:
Consultee ID:
Agent ID:
Data Protection Act 1998 and Freedom of Information Act 2000
Representations cannot be treated in confidence. Regulation 30 of the Town and
Country Planning (Local Development) (England) Regulations 2004, as amended,
requires copies of all representations to be made publicly available. The Council will
also provide names and associated representations on its website but will not
publish personal information such as telephone numbers, emails or private
addresses. By submitting a representation on the Wealden Local Plan Issues,
Options and Recommendations Consultation you confirm that you agree to this and
accept responsibility for your comments.
Signature
Please print name if submitting electronically
(c) Asian or Asian British
Indian
Pakistani
Bangladeshi
Other Asian please say
which
(f) Traveller
Gypsy/Romany
Irish
Any other Traveller please
say which
(a) White
British
Irish
Other White please say
which
(d) Black or Black British
Caribbean
African
Other Black please say
which
(b) Mixed
White and Black
Caribbean
White and Black African
White and Asian
Other Mixed please say
which
(e) Chinese or other
ethnic group
Chinese
Any other ethnic group
please say which
EQUALITY MONITORING
We want to be sure that we treat everyone who uses our
services equally. Answers to the following questions will tell
us more about our customers. Any information you give will
be treated in the strictest confidence and will be used only to
help us to improve our services. You do not have to fill this in
but it will help us if you do.
Gender
Male Female Trans-gender Trans-sexual
Age 15 and under 16-19 20-29 30-39 40-49
50-59 60-69 70-79 80 and over
Marital status single married civil partnership
widowed divorced partner or co-habiting
Religion or belief Christian (all denominations)
Muslim Judaism/Jewish Hinduism Sikhism
Buddhism Other No religion or belief
Sexual orientation Heterosexual Lesbian or gay
Bisexual Prefer not to say
Do you consider yourself to be disabled? Yes No
(The Disability Discrimination Act defines a disabled person as someone who has a physical or
mental impairment that has a substantial and long-term adverse effect on his or her ability to
carry out normal day-to-day activities).
Physical impairment Communication or speech impairment Mental Health
Hearing impairment Visual impairment Learning disability/difficulty
Long-term illness or health condition
Ethnic background (choose the sections from (a) to (f) that apply, then tick the appropriate
box to indicate your ethnic background).
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