Private Tenant Questionnaire - Tenant Advice Service

Private Tenant Housing Disrepair Claim

Thank you for submitting your claim. We specialise in Housing Disrepair. If you would like to use our no-win no-fee service for private tenant's, please complete this form and provide as much information as possible. We can only deal with your case once we receive the requested information on this form.

Client Details

Tenant Name

First Last

Address(Required)

Street Address Address Line 2 City ZIP / Postal Code

Tenant Phone

Tenant Email

Tenant Date of Birth

Defendant Details

Landlord Name:(Required)

Landlord Address(Required)

Street Address Address Line 2 City ZIP / Postal Code

Landlord Phone Number :(Required)

Landlord Email :(Required)

Tenancy Details

Please capture all tenancy details

Tenancy Start Date

How Much Rent Do You Pay?

Is This Per Week or Month?

Any Rent Arrears

Rent Arrears Amount:

Tenancy Type

Single

Joint

Tenant Details

Name	Date Of Birth	Actions

There are no Entries.

Did you pay a deposit?(Required)

Yes

Was you deposit protected with one of the government schemes?(Required)

Yes

Important Information

Have you or anyone at the property suffered any illness due to the disrepair that your doctor is aware of?

Please provide more details of illness

Has the Landlord ever tried to take any action against you? Possession proceedings, anti-social behaviour etc.

Please provide more details

Are you subject toa debt relief order or bankruptcy?

Please provide more details

Do you have any shared ownership of the property?

Have you contacted any other solicitors in relation to the disrepair?

We're sorry. If you have already instructed a solicitor, we cannot help you. Please speak to your existing solicitor.

Disrepair Details

Go through the property room by room

Room name	Disrepair Details	When was it first reported?	When was it last reported?	How did you report the disrepair?	What has the landlord done so far?	Any additional comments in relation to this disrepair	Do we have evidence of this disrepair such as images or video?	Actions

There are no Entries.

Special Damages

Special

Special Damages	Cost?	Do you have a receipt?	Actions

There are no Entries.

Please upload images

Drop files here or

Accepted file types: jpeg, jpg, Max. file size: 20 MB, Max. files: 15.

Please upload images of the disrepair. The maximum number of files you can upload is 15 and total size must be less than 20MB. Alternatively, please send the images by WhatsApp by following this link: https://wa.me/message/HH6SD7XHZIJAL1

IMPORTANT(Required)

I confirm that I wish to start a claim for housing disrepair against my landlord.

IMPORTANT: By submitting this form you confirm that you wish to make a claim for housing disrepair against your landlord. If you are not serious about making a claim, please do not submit this form. If we accept your case, our service is no win no fee as long as you cooperate with us. If you cancel your claim withour prior agreement with us or reach a settlement with your landlord without our agreement, we will charge you for our service, otherwise you pay nothing to us. Please understand it costs us to set up a claim and to process it. We will review your form and assess whether to accept the case. Completing this form does not mean we have accepted your case. Please confirm you agree to this statement

IMPORTANT: Please note that most private landlords will try to evict you after they pay compensation if you pursue a claim against them.(Required)

I understand that my landlord may try to evict me even if I am successful in my claim.

By clicking "Submit", you agree to our Terms of Use and Privacy Policy. You consent to receive phone calls and SMS messages from Us to provide updates on your Claim. Message frequency depends on your activity. You may opt-out by texting "STOP". Message and data rates may apply.

Private Tenant Housing Disrepair Claim

Client Details

Defendant Details

Tenancy Details

Important Information

Disrepair Details

Special Damages

Open Time

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Tenant Advice Service is a service from Amin Haque Solicitors