Assisted Collection Request Form

By completing the form below you are requesting assisted collection for your household waste. The Council will consider each application on its merits and will only provide an assisted collection service if you cannot genuinely move your refuse bin, purple refuse bags or recycling boxes and bags. 

As part of the application process a home visit will be carried out by a waste monitoring officer upon receipt of your application form. Please include a contact number on the form so that an appointment can be booked with you.

If you qualify for assisted collections you will be notified within 10 working days.

*Please note, if you are applying for assisted collection due to medical reasons you will need to provide a letter and signature from your District Nurse, Health Visitor or Care Worker to validate your request.


By submitting the form below I declare that the information in the form is a true representation of my current circumstances. I understand that the provision of an assisted collection service is periodically reviewed and that giving false information will result in the cancellation of the assisted collection. If my circumstances change I will inform the Waste Management Team as soon as possible on 01773 841326 or

The data submitted via this form will be processed and stored electronically by the Council.

In compliance with the General Data Protection Regulations I would inform you that:
  • The legal basis for processing this data is Article 6 (1)(a) of the General Data Protection Regulations.
  • All data will be deleted in accordance with the Councils data retention policy.
  • We will not pass you personal data on to anyone else.
  • You have the right to see the personal data we hold about you; if you think it is wrong you can ask us to put it right; if you think that we have no legal grounds for retaining the information you have the right to ask for it to be erased; if there is a query on the accuracy of the data you have the right to ask us to stop processing your information.
  • The Council’s Data Protection Officer can be contacted on. Tel 01773 570222. Email
  • If you are unhappy with how the Council deals with your personal information you may wish to contact the Information Commissioner. Tel 0303 123 1113; email -; web site -

Assisted Collection Request Form

Confirmation of Data processing


If the property is in the Amber Valley area please enter the postcode or the first few letters of the street. Otherwise enter the full address in the box below.


Contact Details
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Do you need further information?

If for some reason you are unable to find the information which you require on our website, you can contact us by the following methods.

address logoTown Hall, Ripley, Derbyshire, DE5 3BT
address logo01773 841326 *Calls are recorded for quality and training purposes
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