Before continuing with this form, please read the following:
In order to qualify for a Severely Mentally Impaired Discount the person for whom the application is being made needs to:
- Have a confirmed diagnosis from a recognised medical practicioner.
- Be in receipt of any of the following benefits:
- Personal Independence Payment (PIP) with the standard or enhanced daily living component.
- Employment and Support Allowance (ESA)
- Attendance Allowance (AA)
- Severe Disablement Allowance (SDA)
- Care Component of Disability Living Allowance (DLA) (highest and middle rate)
- An Increase in Disablement Pension for Constant Attendance.
- Disabled Person's Tax Credits (following prior entitlement to Incapacity Benefit or Severe Disablement Allowance OR Income Support from 1 April 1997 which included the Disability Premium due to the claimant's incapacity for work)
- Un-employment Supplement (abolished in 1987, existing claimants remain entitled)
- From 1 April 1994, Income Support (IS) which includes a Disability Premium because of the claimant's incapacity for work.
- Constant Attendance Allowance payable under Industrial Injuries or War Pension Schemes.
- Un-employment Allowance payable under Industrial Injuries or War Pension Schemes.
If there is more than one severely mentally impaired person in the property, please complete one form per person.
