You are asked to provide the following information, to enable any and all claims you may wish to make under Human Rights legislation to be fully considered by this Local Planning Authority when determining either your planning application, and/or whether or not to commence any enforcement action/injunctive proceedings. I would recommend that you seek independent professional advice from either a Solicitor or experienced planning agent before acting upon this request. You do not have to provide this information, although this is your opportunity to put forward to the Council, any information you would wish to be taken into consideration. This information will only be used for this purpose, although it must be available for public inspection on any planning application, and will also be included in any report to the relevant Plans Sub Committee, which is also available to the public. Should you have any information of a confidential nature, such as personal medical information, that you would not wish to be made public, I would ask that you indicate that particular information on this questionnaire, and submit the information on a separate sheet. Any information provided will be the subject of enquiries to verify. This information is required by: -----------------------------------------------------------------------------------------------------------------

1. Full names and dates of birth of all adults and children occupying this site.(One form for each family please) ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 2. The names of the current school, or nursery attended by each child named above, the date they first attended the school/nursery, together with contact name, and telephone number if known, at each school or nursery. …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 3. Are you in contact with the Gypsy/Traveller Education Service? Yes/No.

4. If yes, please give contact name and telephone number if known. …………………………………………………………………………………………………………………………………………………………………… 5. The names and addresses of any previous schools/nursery attended, by any above named child, including dates attended. ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 6. Give details of any special educational needs of any child named above, and details of the related tuition in respect of these needs. ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 7. Who owns the land on which you are currently living? Include address and telephone number if known of any owner. …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 8. What date did you take up occupation of this site? …………………………………………………………………………………………………………………………………………………………………… 9. Why did you decide to occupy this site? …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 10. Where were you living/staying immediately prior to taking up occupation of this site? Give address, dates of occupation, and reason for leaving this site. …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 11. Give addresses of, dates of occupation, and reasons for leaving all previous sites where you have lived/stayed in past 5 years. ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 12. Have you applied to reside on any Council owned site? Yes/No

13. If yes, please give names and address of site, and contact name and telephone number of any Council official. ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 14. Have you made any other enquiries about alternative sites. Yes/No.

15. If yes, please give details of where and when? …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 16. How long do you intend to remain on this site? …………………………………………………………………………………………………………………………………………………………………… 17. If you are required to vacate this site, where will you relocate your caravans/family? ………………………………………………………………………………… ………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………………………… 18. Do you have any family association with other persons in this locality. ( ie. in this Council area, or adjoining Council area). Yes/No.

19. If yes, please give names, family relationships, and addresses of any such person. ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 20. How many mobile homes, and/or caravans, (including touring caravans) do you have on this site? …………………………………………………………………………………………………………………………………………………………………… 21. How many motor vehicles, including cars, vans and lorries do you have on this site? …………………………………………………………………………………………………………………………………………………………………… 22. Give name and address of any Doctor with whom you or any other member of your family are Registered? ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 23. Give details of any medical condition, (including any woman who is pregnant), either you or any member of your family, is currently being treated for. ………………………………………………………………………………… …………………………………………………………………………………

24. Give names and address of any hospital which you, or any member of your family is currently attending? ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 25. Do I have your permission to contact either the above Doctor or Hospital to verify the information you have provided? Yes/No.

26. Do you claim Gypsy status as defined under Planning Guidance? Yes/No.

27. If yes, please give reasons. ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 28. What is the nature of the employment of yourself, and any other adult named above? Give name and address of any employer. ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 29. Any other information you would wish to be considered. ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… Signed:

Dated:

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