Title Page
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Conducted on
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Prepared by
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Location
Initial Criteria
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Have you sought previous legal advice for this disrepair before?
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Can you provide the name of the solicitor firm you instructed?
Tenancy Type
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Single or Joint Tenancy?
Tenant 1 Details
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Tenant 1 Title
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Tenant 1 First Name
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Tenant 1 Middle Name
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Tenant 1 Surname
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Address
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Town
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Postcode
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DOB
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Contact Number
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E-Mail Address
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Best Time to Contact
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Name of anyone assisting tenant with the case *if applicable*
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Tenant 1 Photo ID
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Tenant 2 Proof of Address
Tenant 2 Details
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Tenant 2 Title
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Tenant 2 First Name
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Tenant 2 Middle Name
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Tenant 2 Surname
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DOB
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Contact Number
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E-Mail Address
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Name of anyone assisting tenant with the case *if applicable*
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Tenant 2 Photo ID
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Tenant 2 Proof of Address
Tenancy Details
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Landlord Name
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Tenancy Start Date
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Can you provide a copy of the tenancy agreement
- Yes
- No
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How much is your rent
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Weekly or Monthly
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Are you in arrears with your rent
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If yes how much
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Have you ever had court proceedings issued against you
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Type of Property
- Flat
- Terraced
- Semi Detached
- Detached
- Bungalow
- Maisonette
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How many occupants in the property?
Exterior Disrepair
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Describe disrepair to the exterior
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When was it first reported?
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When was it last reported?
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How was it reported?
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Photographs of exterior disrepair
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Videos of exterior disrepair
Hallway Disrepair
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Describe disrepair to the hallway
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When was it first reported?
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When was is last reported?
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How was it reported?
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Photographs of the hallway disrepair
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Videos of hallway disrepair
Kitchen Disrepair
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Describe disrepair to the kitchen
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When was it first reported?
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When was it last reported?
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How was it reported?
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Photographs of the kitchen disrepair
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Videos of kitchen disrepair
Living Room Disrepair
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Describe disrepair to the living room
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When was it first reported?
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When was it last reported?
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How was it reported?
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Photographs of the living room disrepair
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Videos of living room disrepair
Dining Room Disrepair
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Describe disrepair to the dining room
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When was it first reported?
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When was it last reported?
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How was it reported?
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Photographs of the dining room disrepair
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Videos of dining room disrepair
Downstairs WC Disrepair
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Describe disrepair to the downstairs WC
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When was it first reported?
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When was it last reported?
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How was it reported?
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Photographs of the downstairs WC disrepair
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Videos of the downstairs WC disrepair
Staircase & Landing Disrepair
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Describe disrepair to the staircase & landing
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When was it first reported?
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When was it last reported?
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How was it reported?
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Photographs of the staircase & landing disrepair
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Video of the staircase & landing disrepair
Bathroom Disrepair
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Describe disrepair to the bathroom
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When was it first reported?
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When was it last reported?
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How was it reported?
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Photographs of the bathroom disrepair
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Videos of the bathroom disrepair
Upstairs WC Disrepair
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Describe disrepair to the upstairs WC
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When was it first reported?
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When was it last reported?
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How was it reported?
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Photographs of the upstairs WC disrepair
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Videos of the upstairs WC disrepair
Bedroom 1 Disrepair
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Describe disrepair to bedroom 1
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When was it first reported?
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When was it last reported?
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How was it reported?
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Photographs of bedroom 1 disrepair
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Videos of bedroom 1 disrepair
Bedroom 2 Disrepair
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Describe disrepair to bedroom 2
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When was it first reported?
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When was it last reported?
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How was it reported?
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Photographs of bedroom 2 disrepair
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Videos of bedroom 2 disrepair
Bedroom 3 Disrepair
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Describe disrepair to bedroom 3
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When was it first reported?
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When was it last reported?
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How was it reported?
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Photographs of bedroom 3 disrepair
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Videos of bedroom 3 disrepair
Bedroom 4 Disrepair
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Describe disrepair to bedroom 4
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When was it first reported?
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When was it last reported?
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How was it reported?
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Photographs of bedroom 4 disrepair
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Videos of bedroom 4 disrepair
Bedroom 5 Disrepair
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Describe disrepair to bedroom 5
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When was it first reported?
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When was it last reported?
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How was it reported?
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Photographs of bedroom 5 disrepair
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Videos of bedroom 5 disrepair
Other Disrepair
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Describe disrepair to other rooms (if any)
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When was it first reported?
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When was it last reported?
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How was it reported?
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Photographs of disrepair
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Videos of disrepair
Reporting Disrepair
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Do you have any evidence of reporting the disrepair?
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Did your landlord respond to you reporting the disrepair?
