SCHEDULE FORMS PRESCRIBED FOR THE PURPOSES OF PART I OF THE HOUSING ACT 1988

FORM No. 6

3.

Details of premises.

(a)

What type of accommodation do you rent?

Room(s)□

Flat□

Terraced House□

Semi-Detached House□

Fully Detached House□

Other□(Please specify)

(b)

If it is a flat or room(s) what floor(s) is it on?

Ground□ First□ Second□ Other□(Please specify)

(c)

Give the number and type of rooms, eg living room, bathroom etc.

....................

(d)

Does the tenancy include any other facilities, eg garden, garage or other separate building or land?

Yes□ No□

(e)

If yes, please give details:

....................

....................

....................

(f)

Do you share any accommodation with:

(i)the landlord?

Yes□

No□

(ii)another tenant or tenants?

Yes□

No□

(g)

If yes to either of the above, please give details:

....................

....................

....................

4. (a)What is the current rent?

£....................

per ....................

(e.g. week, month, year)

(b)Does the rent include council tax?

Yes□

No□

(c)If yes, the amount that is included for council tax is:

£....................

per ....................

(e.g. week, month, year)

(d)Does the rent include water charges?

Yes□

No□

(e)If yes, the amount that is included for water charges is:

£....................

per ....................

(e.g. week, month, year)