Your details Name Customer name Title Title - Select -MissMsMrMrsDrOther… Enter other… First Last Address Customer address Address Address 2 City/Town Post Code Contact Telephone number Email address Details of the deceased Name Name of the deceased Title Title - Select -MissMsMrMrsDrOther… Enter other… First Last Address Address of the deceased Address Address 2 City/Town Post Code Contact Telephone number Email address Additional details Date of death Was their property owned or rented - Select -OwnedRented Is the property empty - Select -YesNo Solicitor details Name Solicitor Name Title Title - Select -MissMsMrMrsDrOther… Enter other… First Last Address Solicitor address Address Address 2 City/Town Post Code Contact Telephone number Email address Landlord details Name Landlord Name Title Title - Select -MissMsMrMrsDrOther… Enter other… First Last Address Landlord address Address Address 2 City/Town Post Code Contact Telephone number Email address The Council is under a duty to protect public funds and, to this end, may use the information held or provided by you for the prevention and detection of fraud. It may also share this information with other bodies, including (but not limited to) Wolverhampton Homes, the Police and other agencies for these purposes and also for the audit or administration, collection and recovery of claims, transactions, applications, taxes and payments and for performing other statutory enforcement duties. For more information visit Fair Processing Notice Data Matching What code is in the image? Enter the characters shown in the image. 10974
