Knowsley Metropolitan Borough Council

Neigbourhood Delivery

Request for a Replacement Maroon Bin

Hardship Assessment

Information you should read before you complete this application form

Knowsley Council is committed to supporting its residents in accessing the services and support they require.

This form will help you to tell us about your support needs. The information you provide will assist us in deciding if you qualify for a free or a discounted replacement maroon bin.

To do this, we need to collect and use information about the people we provide services to and others we have contact with. We may share information you provide on this form, within the Council and with Government bodies and other local authorities but only where it is necessary and the law allows it. Under no circumstances will we share your personal information with third parties for commercial purposes.

In compliance with the Data Protection Act 1998, we ensure that information that you give us is kept safe and secure and treated confidentially.

If you would like to know more about what we do with your information please visit our website www.knowsley.gov.uk and click on our privacy policy.

Your details
Name
National Insurance Number:
Address
Contact details
Telephone number
Mobile Telephone number
Email address

Questions about you

Are you the property tenant? or property owner?

How many people live at the address?

Have you applied for assistance through the Council’s Emergency Support Scheme during the last 6 months?

Emergency Food Bank Voucher / Yes / No
Emergency Fuel Voucher / Yes / No

Do you currently receive any of the following benefits/help? (Please circle Yes or No)

Benefit Type
Income support / Yes / No
Income based job seekers allowance / Yes / No
Income related employment support allowance / Yes / No
Any type of pension credit / Yes / No
Means tested housing benefit / Yes / No
Means tested council tax reduction / Yes / No
Universal Credit / Yes / No

Please use the box below to provide any other information in support of your application for a free or discounted replacement maroon bin.

As part of this application process, you may be asked to provide proof of the support you have received or applied for. Failure to provide this information, or to provide false or misleading information, will result in your application being declined.
By signing this Hardship Assessment Form, you also consent to the Council undertaking relevant checks to confirm your receipt of the above referenced financial assistance and / or benefits.
Signed :
Date:

OPERATIONAL SUPPORT ONLY

Date Received…………………….

Approved Rejected Service Manager……..………………………