Please complete this form if there is a person with a severe mental impairment living in the property. You will be required to provide evidence of your benefits and confirmation from your Doctor as part of this form. The form for your doctor to complete is available here
. You can complete the form below and attach the confirmation from your doctor as a scanned image or send it to the Council separately.
Please have your documents ready for upload before starting to complete this form. If you need to scan your documents now, you should refresh this page BEFORE you start to fill in your details.
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Please complete all of the questions marked with an asterisk.
In order to maintain security, this form will time out after 30 minutes.
None of the information is retained if you do not submit the form. You will lose all the information if the form is not completed.
Please give the following details relating to the person who is severely mentally impaired
Which of the following benefits does this person receive? Please tick all that apply.
We must see proof of these benefits and the date each benefit started to support your application.
The information given on this form may be held on computer to enable Lewisham Council to meet its statutory duties.
We may use the information you have provided to prevent and detect fraud.
We may also share this information with other councils or agencies that handle public funds.