BARN Recycling and waste ‘Assisted Collection’ service application Section 1: Address Details we) Mice) Mis) Mc ba rane She: : adios Postcode Telephone No, ial addrass Ts there someone else (such as a family member) who you would like us to contact sto of you, ite mood to conta someone sbou te ppieston? oy Flatonstip | Tgevhone Email aderess: Section 2: Service Reasons Plaase state the reason you require the Assisted Collection service: ‘What copies of rolevant documents are being provided as evidence of your need? [Breceipt of Personal Independence Payment [receipt of Disability Living Allowance Bltter from @P other Please note: Please only send copies of documents, as we cannot return any documentation submited. Section 3: Length of Service required” Under] 3106 | 61012 lease state how long you Ongoing’ Fey need the Asetstod months | months | months Collection a a o o ‘minimum once every three years. ‘Section 4: Location of waste containers “Please note that a‘Assisied Collection service provided forless than 12 months will automatically cease after that period of time, unless you advise the Council otherwise, Please note all on-going Assisted Collection services we provide will be reviewed ata Please describe the location of your waste containersSection 6: Declaration Declaration: | deciare thatthe information given in this orm is true and accurate, Signature Date Please return your application form and relevant documents to: Email: streetscenecorrespondence @ bamel.gov. uk oR Post: Street Scene service ~ Assisted Collections ‘The London Borough of Bamet Oakleigh Depot Oakleigh Road South London Nit 1H How your information will be used The information we collect on this form willbe used to assess whether you meet the crtria for the service and arrange how best to help you. If we accept your application, we wil note your address on our list of prnnartins receiving an assisted collection, but wo will destroy the copie ‘of evidence you have provided. Remember: if your needs or circumstances change you need to let us know so that we ‘can reassess your eligibility for the service or see whether we need to change the way ‘we help you. Bamot Council wit collect and use the information you give us to undertake our functions as a local authority and deliver services to you, is our responsibilty to ensure that your information {is kept safe. Where necessary and legally allowed, we will share your information with trusted ‘external organisations, commissioned partners and contracted service providers in der to deliver services and support to you. ‘The information we collect may be used to better understand your use of our services and assist us in improving our services. This is to ensure we are using public nds in tho bast Possible way. Under our duty to protect public money we may use the information you have provided forthe prevention and detection of crime. For further details of how we use your information and to understand your rights please visit ww bamet,gov.uldprvacy or email data.protection @ barat gov.uk to request afl copy of our privacy notice.