* 1. Are you making representations / submissions on behalf of?

* 2. Are you?

* 3. Are you in favour of?

* 4. If you wish to increase or decrease the LAF, by what range do you wish to adjust the LAF?

* 5. Are you aware that a change in the Local Adjustment Factor (LAF) will have an impact on the level of services provided by the Local Authority?

* 6. Additional comments/observations:

* 7. Name:

* 8. Address:

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