South Ayrshire Council

1. Name*  
2. Rates Reference*  
3. Property Address*Address  
4. Exact date the property became unoccupied*    
5. Date the property will be occupied
   (If the full period is unknown, please provide your best estimate)
6. Reason for the premises not being occupied*Reason   

7. It may be necessary to inspect your premises to substantiate your claim.

   I confirm that inspection of the property can be arranged by contacting:

   Name*  
8. Address*Address   
9. Telephone*  

1. If any change has taken place since the subject became 'empty' please complete below as relevant.

   New Owner
2. Date of Sale
3. Solicitors Name
4. Solicitors AddressSolicitors Address
5. Forwarding AddressForwarding Address
6. Telephone

1. Date of termination of tenancy
2. Name of New Tenant
3. Alternative AddressAlternative Address
4. Owner's Name
5. Owner's AddressOwner's Address
6. Your Forwarding AddressForwarding Address
7. Telephone

I believe that the property for which I am responsible should be exempt from the Empty Property Rate because

(please choose one)

1. Industrial propertyProperty is prohibited by law from occupation
   Property has a Rateable Value of less than £1500 (1/4/1995 – 31/3/2000) Property is under compulsory purchase order
   Property has a Rateable Value of less than £1700 (from 1/4/2000)Property is subject to a Preservation Order, or is a Listed Building or is a scheduled Ancient Monument
   Property is unoccupied due to death or insolvency

I/We believe that the information supplied is to the best of my knowledge and belief accurate.
I/We understand that to deliberately provide false information for monetary advantage is a criminal offence.

1. Form completed by*  
2. Position held in business*  
3. Blank field proves you are not spam
   Leave blank