Council Tax Liability Order Request for Information

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Your Details

Forename

Surname

Phone Number

Email Address

Address

Recently Used Address

Address

If you are using a screen reader, do not fill in this field If you are using a screen reader, do not fill in this field

Enquiry Details

If you have received a Liability Order Request for Information Form through the post, you may use this form to submit the required information requested online. Failure to complete this form in full or make payment in full within 7 days of the Liability Order will result in your arrears being passed to an Enforcement Agent for collection and you will be liable to pay their additional fees for collection.
Each member of the household who has received a Liability Order must complete their own form.

Please confirm your Employment status

Employed Self-employed Not Employed

Is your Partner employed or self-employed?

Yes No

Please provide the details of the employer referred to above

Name of Employer

Telephone Number of Employer

Address of Employer

Please provide your Payroll OR National Insurance Number

Please state how often you get paid

Weekly Fortnightly Monthly

Please state your earnings after deductions

Are you receiving sick pay from your employer?

Yes No

Do you receive Universal Credit?

Yes No

Do you receive Income Support?

Yes No

Are you the

Claimant Partner to Clamant

Please state your National Insurance Number

What is your Date of Birth

Do you receive any of the following?

Job Seeker's Allowance State Pension Employment Support Allowance Pension Credit Sickness Benefit Private Pension Bereavement Support Payment

If your source of income is not listed, please confirm where your income is from

Your Proposals for Payment

Please outline below your proposals to pay the outstanding Council Tax amount. Your proposals will be considered and a reply will be sent to you to confirm whether or not this is acceptable. You should start making payments immediately.

Household monthly net income including all members of your household

Your own individual net monthly income

Proposed Payment

Frequency

Weekly Monthly 4 Weekly on a Monday Other

Please specify other frequency

Your proposals will not be considered, and your account will be passed to the Enforcement Agent, if you do not fully complete all relevant questions

Declaration

The information I have given on this form is correct.

Your Full Name

Date signed