1 Start 2 Complete This form is the apply for a large wheeled bin for non hazardous medical waste. Nappies are not classed as medical waste. Name * Address * Postcode * Telephone number or email address * How many adults live in your household on a day to day basis? * 1 2 3 4 5 More How many children live in your household on a day to day basis? * 0 1 2 3 4 More Please explain your reasons for needing a larger grey wheelie bin * Is this a temporary condition? * Yes No If yes, how long do you expect the condition to last for? Please tell us which of these you use: * Brown recycling wheelie bin Blue recycling wheelie bin Garden green wheelie bin None If you don't have these bins would you like to receive them? Yes No Not applicable Declaration * I certify that all information given in this form is true and correct. I understand that false information will result in the removal of any larger bin provided which will be replaced with a 180 litre bin. I will notify Selby District Council, should there be any change in the circumstances relating to my application. Yes No
