Subject: Waste and recycling
Author: Simon Williams
Last saved by: Laura Webb

Department for Place

Extra black bin request form

Complete this form 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 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 carefully before returning your form to us.

I agree to the 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.