Differential Rates Submission Form Your details Page1 / 2 50% of survey complete. Question Title * Submissions are limited to electors or ratepayers, are you one of the following? Elector Ratepayer Both Neither (submission will not be accepted) Question Title * First name Question Title * Surname Question Title * Year of birth (four digits e.g. 1985) Question Title * Email address: Question Title * Daytime contact number: Question Title * Street address: Question Title * Suburb: Alfred Cove Applecross Ardross Attadale Bateman Bicton Booragoon Brentwood Bull Creek Kardinya Leeming Melville Mount Pleasant Murdoch Myaree Palmyra Willagee Winthrop Suburb not listed? Share your postcode or suburb name Question Title * Which of the following applies to you, or the person you are completing this submission on behalf of? Please select all that apply. Aboriginal or Torres Strait Islander From a culturally and linguistically diverse, migrant or refugee background Living with disability, neurodivergence, or lived experience of mental health challenges Identifies LGBTQIA+ community Question Title * What does your submission relate to? Objectives and Reasons Rating categories Impact on me/my property Support / concerns I have no comments Other (please specify) Acknowledgements Question Title * Do you consent to your name being published in association with your submission, including in any reports or documents presented to Council? Yes No Question Title * I acknowledge and agree to the terms and conditions and consent to the collection and use of my personal information in accordance with the City’s Privacy Policy. Yes No Next