Extra black bin request form

Complete this questionnaire to request an extra black bin for your non-recyclable household waste.

Applications are assessed on a case-by-case basis and we may arrange a visit to confirm your needs.  

You must read the terms and conditions at the bottom of this form before you send us your request for an extra black bin. 

Children in nappies 
We provide a separate, free service for nappy waste from children under 5 years old. Find out more.

Medical conditions
If you or someone in your household have a medical condition that causes extra non-recyclable waste such as incontinence pads or non-infectious waste, the extra black bin service is free of charge.

Clinical waste
We provide a separate collection for clinical waste (infectious or likely to infect others) which cannot go in with your other waste. If you are not sure whether you need a clinical collection, ask your healthcare practitioner. Find out more.

Houses of Multiple Occupancy (HMOs) and flats
This is a property where individual rooms are rented out by a landlord. If you live in an HMO your landlord must apply for an extra black bin. 

If you live in a flat with shared waste and recycling bins please call 01454 868000.

Your details/person requesting an extra black bin

1.	Name of applicant:

2.	Address and postcode of property where the bin is requested:

3.	Email address:						Phone number:

We need to know about the people living in your household

4.	How many people live permanently at your property? Put a number next to the options that apply.
•	Children under 5: 
•	5 to 17 year-olds: 
•	Adults (18 years and above): 

5.	How many people in the household have medical needs that result in extra waste? Put the number below:

6.	What type of waste is produced from the medical condition? For example, incontinence pads. List items/type of waste below.

7.	How much medical waste is produced each week (black bin bag size bags)? Put a Y next to the option that applies.
•	less than 1 bag: 
•	2 bags: 
•	3 or more bags: 
	     	        	      	
8.	How many children under 5 years old in nappies live at the property? Put a number below.

9.	Is it likely they will stop needing nappies within the next 12 months? Put Y or N below.

10.	Is the property a House of Multiple Occupancy (HMO)? Put Y or N below.

We need to know about your household waste and recycling

11.	How many extra bags of waste do you normally have on collection day that do not fit in your bin? Put a number below.

12.	What are the main types of waste you put in your black bin? List specific examples below such as nappies, polystyrene, plastic bags and wrapping:

13.	What do you currently recycle using the weekly collection service? Please circle or highlight the items you recycle below.
Aerosols			Clothing and shoes		Paper
Batteries			Foil				Pet bedding (rabbits/guinea pigs)
Cans			Food				Plastic bottles, tubs, trays
Cardboard		Garden waste		Small electrical items
Cartons (Tetra Pak)	Glass bottles and jars

14.	Do you take any waste or recycling to the Sort It recycling centres? Put a Y or N below.

15.	What items do you normally take? Give examples such as cardboard boxes, garden waste, furniture, polystyrene, extra bags of non-recyclable waste below.

16.	Why are you requesting an extra black bin for non-recyclable waste? Use this space to tell us more about why you are requesting an extra bin.

Read the terms and conditions below carefully before returning your form to us.

Terms and conditions of the extra black bin service

1.	Your black bins must not be used for any items which can be recycled using the kerbside collection service. 

2.	South Gloucestershire Council may monitor how you use these bins and carry out checks to ensure they are only being used for non-recyclable waste. Recyclable items found in your black bins must be removed within 14 days. If you continue to put recyclable items in the bins, we will remove your extra capacity bin and you may no longer be eligible to receive the service. No refund would be given.

3.	You must ensure the approved sticker we provide for your extra bin is visible and report any damage to us as soon as possible. If the sticker is not visible on your bin the collection crews will not empty it.

4.	You must put the bin out at the edge of your property or agreed collection point by 7am on the day of collection with the lid fully closed.

5.	If you move property within South Gloucestershire, you must take the extra bin with you and inform us as soon as possible to continue receiving the service. We will send you a new approved sticker to attach to your extra bin. 

6.	We will reassess your requirements for the extra black bin every 12 months and may carry out a waste audit as part of this process.

7.	This service has an annual administration charge unless the extra bin is needed due to a medical condition. This is non-refundable. There is a reduction of the charge if you are in receipt of Income Support, Pension Guarantee Credit, Income-based Job Seekers Allowance or Income-based Employment and Support Allowance. The administration charge is not applied to households who need the service on medical grounds. The cost of this service is available on our webpage.

8.	The extra black bin remains the property of South Gloucestershire Council.

I agree to the above terms and conditions: Y / N

Signed: 					Date:
If returned by email, your email will be accepted as a signature.

Return this form by email to waste.management@southglos.gov.uk or post to Department for Place, South Gloucestershire Council, PO Box 1954, Bristol BS37 0DD

If you need recycling containers, order them for free or call 01454 868000.

If you need help to complete this questionnaire email streetcare@southglos.gov.uk, call 01454 868000 or visit our One Stop Shops at Thornbury, Patchway or Yate.

All personal information supplied will be held by South Gloucestershire Council. Aspects of this information needed to operate the collection of the extra capacity refuse bin will be shared with our waste contractor Suez in accordance with the Data Protection Act. This information will be used as part of this service only and will not be shared with any other organisation.