Title Page
-
Client Name
Housing Disrepair Claim Form
-
Title
-
First Name
-
Middle Name
-
Last Name
-
Date Of Birth
-
Email
-
Contact Number
-
Alt. Contact Number
-
Proof Of ID
-
Proof Of Address
-
Address
-
Joint Tenancy?
-
First Name
-
Middle Name
-
Surname
-
Date Of Birth
-
Proof of ID
-
Proof of Address
-
Password
-
Landlord Name
-
Landlord Address
-
Tenancy Details
-
Tenancy Start Date
-
Do you have a copy of your tenancy agreement?
-
Did you pay a deposit?
-
How much rent do you pay?
-
How often is this paid?
-
Are you in receipt of housing benefit?
-
Do you have any arrears?
-
Property type?
-
Damage Summary
-
Why you believe this is a case
-
Have you complained to the landlord?
-
First complained to the landlord Date?
-
Last report to Landlord
-
Details of complaint to landlord
-
Has the landlord responded to complaints?
-
Are there loose or broken roof tiles?
-
Are there cracks in the external walls?
-
Are there cracks in the internal walls?
-
Are the extractor fan working? *If not, list each room
-
Is there damp or mould?
-
Are the doors or window frames rotting?
-
Are the doors or window frames broken?
-
Are there faulty electrics?
-
Is the boiler faulty?
-
Is the radiator faulty?
-
Are any pipes leaking?
-
Are any sanitary fixtures broken?
-
Are any floorboards rotting?
-
Are any floors unsafe or damaged ?
-
Are there any vermin?
-
Are there any pest infestations?
-
Has the disrepair caused health issues?
-
Has the disrepair caused inconvenience?
-
Have you signed up with any other solicitors for this matter?
-
Other issues you want to tell us?
-
Have you had any financial losses due to the disrepair?
Rooms Affected
-
Name of Room
- Bathroom
- Kitchen
- Living Room
- Dining Room
- Hallway
- Separate Toilet
- Bedroom 1
- Bedroom 2
- Bedroom 3
- Bedroom 4
- Bedroom 5
- Whole Property
- Utility Room
- Outside
-
First Report
-
Last Report
-
External Image
-
Description of damage
-
Internal Image
