Housing Disrepair Report - HDH

• Client Name and Ref No

• Title

• First Name

• Middle Name

• Last Name

• Date Of Birth

• Email

• Contact Number

• Alt. Contact Number

• Proof Of ID

  Media

• Proof Of Address

  Media

• Address

• Joint Tenancy?

  Yes

  No

• Joint Tenant - First Name

• Joint Tenant - Middle Name

• Joint Tenant - Surname

• Date Of Birth

• Proof of ID

  Media

• Proof of Address

  Media

• Have you signed up with any other solicitors for this matter?

  Yes

  No

  N/A

• Landlord Name

• Landlord Address

• Tenancy Details

  Assured Shorthold Tenancy

  Temporary Accomodation

  Sheltered Accomodation

  Private Landlord

• Tenancy Start Date

  Date

• Do you have a copy of your tenancy agreement?

  Yes

  No

  N/A

• Did you pay a deposit?

  Yes

  No

  N/A

• How much rent do you pay?

• How often is this paid?

• Are you in receipt of housing benefit?

• Do you have any arrears?

  Yes

  No

• Do you have a payment plan in place ?

  Yes

  No

  N/A

• How much is your payment towards your arrears each month?

• Do you have any following previous credit issues?

  Select Bankruptcy Insolvency Voluntary Agreement (IVA) Debt Relief Order (DRO) County Court Judgement (CCJ's) None

  • Bankruptcy
  • Insolvency Voluntary Agreement (IVA)
  • Debt Relief Order (DRO)
  • County Court Judgement (CCJ's)
  • None

• Property type?

  Select Terraced Detached Semi Detached Flat Maisonette Townhouse Bungalow Apartment Other

  • Terraced
  • Detached
  • Semi Detached
  • Flat
  • Maisonette
  • Townhouse
  • Bungalow
  • Apartment
  • Other

• How many bedrooms?

Reporting & Landlord Response

• Have you complained to the landlord?

  Yes

  No

  N/A

• First complained to the landlord Date?

• Last report to Landlord

• Method of reporting

• In the past 3-6 months how many times have you reported these issues?

• What has been the landlords' response ?

• Have any repairs been carried out within the past 3 months ?

• Are any repairs scheduled by your landlord ?

Rooms Affected

• Name of Room

  Select Bathroom Kitchen Living Room Dining Room Hallway Separate Toilet Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Bedroom 5 Whole Property Utility Room Outside Landing

  • Bathroom
  • Kitchen
  • Living Room
  • Dining Room
  • Hallway
  • Separate Toilet
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • Bedroom 5
  • Whole Property
  • Utility Room
  • Outside
  • Landing

• First Report

• Last Report

• How often has this been reported in the past 6 months ?

• Description of damage

• Are there loose or broken roof tiles?

  Yes

  No

  N/A

• Are there cracks in the external walls?

  Yes

  No

  N/A

• Are there cracks in the internal walls?

  Yes

  No

  N/A

• Are the doors or window frames affected?

  Yes

  No

  N/A

• Is there damp or mould?

  Yes

  No

  N/A

• Are there faulty electrics?

  Yes

  No

  N/A

• Is the boiler faulty?

  Yes

  No

  N/A

• Are the radiators faulty?

  Yes

  No

  N/A

• Are any pipes leaking?

  Yes

  No

  N/A

• Are any sanitary fixtures broken?

  Yes

  No

  N/A

• Are any floorboards rotting?

  Yes

  No

  N/A

• Are any floors unsafe or damaged ?

  Yes

  No

  N/A

• Are there any vermin?

  Yes

  No

  N/A

• Are there any pest infestations?

  Yes

  No

  N/A

• Do you have working extractor fans? *If not, list each room

  Yes

  No

• Has the disrepair caused health issues?

• What inconvenience has the disrepair caused for you and your family?

• Have you had any financial losses due to the disrepair?

• Other issues you want to tell us?

• Damage Summary

• Why you believe this is a case