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Section 1
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Request an assisted household waste and recycling collection
Number of people living in the household?
*
Number of able-bodied people living the household?
*
Do you already receive an assisted collection?
*
Do you already receive an assisted collection?
Yes
No
If Yes, please indicate which service you already receive an assisted collection for
Green/Grey bin (General household waste)
Brown organic waste bin
Recycling boxes (Paper, glass and cans)
Textiles collection bag
Do you have a blue parking badge?
*
Do you have a blue parking badge?
Yes
No
If Yes, please supply your blue badge serial number
Reason for requesting an assisted collection (please tick as appropriate)
*
I am registered as disabled
I have a physical/medical condition/infirmity that means I am unable to move my rubbish for collection
Please provide further details explaining why you require an assisted collection
Are you temporarily incapacitated (e.g recovering from an operation)
Are you temporarily incapacitated (e.g recovering from an operation)
Yes
No
If Yes, please specify how long you will require an assisted collection for
Please indicate where your containers can be easily collected from and returned to
*
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