Information
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Rent account number
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Location
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Property address
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Rent account balance
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Audit completed on visit number...
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Staff member completing audit
- Chris Rourke
- Adetoun Ajayi
- Myra Dicken
- David Crofts
- Thomas Austin
- Michael Opreshko
- Sarah Thompson
- Tee Aminu
- Dee Salter
- Vicki Percival
- Marie Booker
- Peter Gillett
Tenancy details / Occupants
Tenancy details
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Tenancy start date
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Tenancy type
Tenants details
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Tenants title:
- Miss
- Mrs
- Ms
- Mr
- Dr
- Rev
- Sir
- Lady
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Please enter tenants full name
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Tenants DoB
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Tenants national insurance number
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Tenants full address
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Contact details (telephone / mobile phone / email etc)
Contact details
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Tenants photo
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Tenants ID
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How do you pay your rent?
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Do you work
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What is your income?
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Proof of income
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Do you work full time or part time?
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What is your income?
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If you are on benefits, list what benefits and total amount received
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Do you have any outstanding debts?
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List debts and amounts
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Is this a joint tenancy?
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Tenants photo
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Tenants ID
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Joint tenants title
- Miss
- Mrs
- Ms
- Mr
- Dr
- Rev
- Sir
- Lady
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Add media
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Please enter joint tenants full name
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Joint tenants date of birth
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Joint tenants national insurance number
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Joint tenants contact details (telephone / mobile phone / email etc)
Contact details
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Do you work
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What is your income?
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Proof of income
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Do you work full time or part time?
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What is your income?
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If you are on benefits, list what benefits and total amount received
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Do you have any outstanding debts?
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List debts and amounts
Condition of property
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Lounge
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Why has it failed?
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Kitchen
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Why has it failed?
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Landing and hallway
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Why has it failed?
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Bathroom
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Why has it failed?
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Garden
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Why has it failed?
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Add media
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Sheds and out buildings
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Why has it failed?
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Add media
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How many bedrooms are in the property?
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Bedroom 1
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Why has it failed?
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Add media
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Bedroom 1
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Why has it failed?
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Bedroom 2
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Why has it failed?
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Bedroom 1
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Why has it failed?
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Bedroom 2
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Why has it failed?
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Bedroom 3
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Why has it failed?
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Bedroom 1
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Why has it failed?
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Bedroom 2
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Why has it failed?
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Bedroom 3
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Why has it failed?
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Bedroom 4
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Why has it failed?
Household
Household
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Please add each childs details
Child details
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Name
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Gender
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Date of birth
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Relationship to tenant
- Son / daughter
- Grand child
- Niece / nephew
- Other
- Step son
- Step daughter
- Parent
- Aunt / uncle
- Grand parent
- Partner
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Please enter relationship to tenant
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Please add each adults details (other than tenant / joint tenant)
Adult details
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Name
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Gender
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Date of birth
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Relationship to tenant
- Son / daughter
- Grand child
- Niece / nephew
- Other
- Step son
- Step daughter
- Parent
- Aunt / uncle
- Grand parent
- Partner
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Please enter relationship
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Identity / proof of residence
Pets
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Are there any pets in the household?
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Please enter each pets details
Pet
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Has pet been registered?
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Species:
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Has the pet been micro-chipped?
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Is the pet neutered?
Property
Property details
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Number of bedrooms
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Property type
- Flat
- Terraced house
- Bungalow
- End of terrace
- Semi-detached
- Maisonette
- Sheltered housing
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Have you been able to inspect all rooms?
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Please provide details of refusal of access:
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Have there been any structural changes to the property during the tenancy?
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Was approval granted?
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Please provide details
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Are there any signs of damage to the property?
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Please give details of damage:
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Please add image if appropriate
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Are there repairs needed to the property?
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Have the repairs been reported?
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Please provide details of repair needed
Hazards
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Are there any combustable materials stored at the property?
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Please provide details:
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Please add image if appropriate
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Is there a smoke alarm at the property?
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Is it hard wired?
Utilities
Utilities
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Does the property have gas, electricity or both?
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Please photograph the meter including piping to the unit (take multiple photos if necessary)
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Please enter the meter reading if not legible in the image
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Please photograph the meter including wiring to the unit (take multiple photos if necessary)
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Please enter the meter reading if not legible in the image
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Please photograph the meter including piping to the unit (take multiple photos if necessary)
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Please enter the meter reading if not legible in the image
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Please photograph the meter including wiring to the unit (take multiple photos if necessary)
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Please enter the meter reading if not legible in the image
Tenant support needs
Financial issues
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Does the tenant have any rent arrears?
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Has an affordable arrangement been put in place and being adhered to?
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Please raise referral to Housing Officer / Welfare Reform Team for affordable repayment plan
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Is the tenant claiming Housing Benefit?
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Is the tenant Under / Over occupying the property?
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Could the tenant satisfy one of the exemptions from size criteria? please select as appropriate
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Would the tenant like to find a larger property?
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Are there any outstanding issues with their HB claim?
- Overpayment
- Suspension
- Information required
- Un-notified change of circs
- None
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Please raise referral to Housing Officer / Welfare Reform Team
Support requirements
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Does anyone in the household have a registered disability?
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Are they in receipt of disability benefits?
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Referrals to be made (please select all)
- AP1
- CP1
- Welfare Reform Team
- CAB
- MacMillian WBU
- Transfer / Mutual exchange
- Residents association
- Other
- Repair
- Stepchange
- Caring hands
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Please give details of support required
Declaration
Comments / Statements
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Officer comments
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Tenants comments
Declaration
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I declare that the information I have given for the purposes of this form is true and accurate. I understand that giving false information may amount to fraud and I would put my tenancy at risk with the result being that I may loose my home. I may also be subject to criminal prosecution.
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Tenant signature
