Tenant/Occupier Details

Tenant Details

Landlord Details

Defect Details

Please see below the Landlords responsibilities-
  1. The structure and exterior of your home, the walls, roof, foundations, drains guttering, external pipes, windows and external doors.
  2. Basins Sinks, Toilet and their pipework.
  3. Water, Gas Pipes, Electrical Wiring, and Water tanks, Boilers, Radiators, Gas Fires, Fitted electric fires or fitter heaters
Please Make sure these are listed in the claim form and that the landlord has been notified of the disrepair, if not the claim will be rejected.

Room 1

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Room 2

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Room 3

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Room 4

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Room 5

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When did you first notice the defects? (Exact Date, be as precise as possible)