Title Page
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Document No.
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Conducted on
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Prepared by
Personal details
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Title
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Birth
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Forename
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Surname
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Postcode
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Address
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Town
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Telephone
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Email
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NI number
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Landlord
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Best time to contact
Tenancy details
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Tenancy status
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Rent / month
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Moving in date
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Rent arrears
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Additional notes
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Tenant Signature
Room
- Room
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Room name
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Disrepair to room
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When reported
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Repaired since reported?
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Images of disrepair
