Before you complete this form
Before you fill in this form, please ensure you have read the notes to this form, the guidance booklet accompanying your levy invoice and the publication "How we deal with your concerns". It is important you read this information as there are a number of formal requirements which must be met before the Reconsideration Committee will reconsider a case and issue a reconsideration decision (note 1).
If you make any mistakes or fail to complete this form properly, this may lead to delays in processing your application or you may lose the right to have the decision reconsidered. (note 2)
Please complete all sections of the form, unless otherwise indicated.