Use this form to:

• Request that a member of the Lifeline team contact you regarding interest in the Lifeline service.

Issues not dealt with in this form:

• Compliments or complaints about the service, these can be sent using our complaints and compliments page.

What you'll need to provide:

• Your contact details including name, phone number and email address.

Your privacy

The information you provide on this application form will be used to facilitate your issues with your address request. The information will only be disclosed to individuals in the Council who require it to complete your request. Please be aware that your information may be passed to the Council’s Counter Fraud Service and/or the Police if we suspect any fraudulent activity. For more information about how we use your personal data please see the Council's Privacy Notice on its website.