Severely Mentally Impaired Discount Exemption Form

Information Page

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 Payments (PIP) (standard and enhanced rate)
    • 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.