Application for the Freeman Roll

Contact Details

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Local Government (Miscellaneous Provisions) Act 1972 Section 248
Application For The Admission To The Pastures Roll of The Enrolled Freeman of Grimsby
In pursuance of the provisions of the above Act, I undersigned, hereby claim to be admitted a Freeman of Great Grimsby and submit the following particulars:-

Part 1 To Be Completed By Every Applicant
Contact Details
Surname ^*
First Name(s) ^*
Address ^*
Postcode ^*
Email address
Telephone Number ^*
Date of Birth ^*
Age ^*
Residence in Great Grimsby
(A) How long have you been resident at the present address: ^*

(B) If this is less that 12 months, state previous address and how long you were resident there
Payment of Council Tax
(A) Are you responsible for payment of Council Tax to North East Lincolnshire Borough Council?

If the answer to (a) is yes, then please also answer (b) and (c)
(B) Please quote your Council Tax reference number (which is shown on the demand)

(C) What is your method of payment (e.g. direct debit, in full etc) This payment is referring to the payment of your council tax

Please note: If the application is approved there will be a nominal fee of £1.13 payable at the time of registration.

DATA PROTECTION NOTICE
North East Lincolnshire Council is a Data Controller for the purposes of the Data Protection Act 1998. Any personal information supplied on this form will be processed in accordance with the principles of the Act. If you want to find out more about your rights under the Act, you can contact the Office of the Information Commissioner (tel: 01625 545 700 / http://www.dataprotection.gov.uk) or the Director of Law and Democratic Services on 01472 313131.



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Local Government (Miscellaneous Provisions) Act 1972 Section 248

Application For The Admission To The Pastures Roll of The Enrolled Freeman of Grimsby

Part 1 To Be Completed By Every Applicant

Residence in Great Grimsby

Payment of Council Tax