Title Page

  • Client Name

  • Prepared by

  • Claim type

Client

  • Title

  • First Name

  • Last Name

  • Date of Birth

  • E-mail

  • Contact Number

  • Alt. Contact Number

  • Address Line 1

  • Address Line 2

  • Address Line 3

  • Address Line 4

  • Postcode

Tenancy

  • Landlord Name

  • Tenancy Start Date

  • Do you have a copy of your tenancy agreement?

  • Is the tenancy single or joint?

  • Joint Tenant First Name

  • Joint Tenant Last Name

  • Joint Tenant Date of Birth (yyyy/mm/dd)

  • Joint Tenant Contact Number

  • Joint Tenants E-Mail

  • Are you named in the tenancy?

  • Did you pay a deposit?

  • How much rent do you pay?

  • How often is this paid?

  • Are you in receipt of housing benefit?

  • if so, how much do you receive?

  • Do you have any arrears?

  • How much arrears ?

  • Do you have a payment plan set up?

Property Details

  • Property type?

  • Kitchen Damaged ?

  • Details

  • Living Room Damaged ?

  • Details

  • Utility Room Damaged ?

  • Details

  • Bathroom 1 Damaged ?

  • Details

  • Bathroom 2 Damaged ?

  • Details

  • Bedroom 1 Damaged ?

  • Details

  • Bedroom 2 Damaged ?

  • Details

  • Bedroom 3 Damaged ?

  • Details

  • Exterior Damaged ?

  • Details

  • Other Damages ?

  • Details

  • Personal Injury or illness due to property conditions ?

  • undefined

Complaint Details

  • Have you complained to the landlord ?

  • First complained to landlord ?

  • Number of complaints made ?

  • Last complained to landlord ?

  • Do you have copies of the complaint correspondence?

  • Has landlord responded to complaints?

  • Has landlord made repairs?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.