Use this form to provide us with all the details you have regarding your Housing Disrepair Claim.
Documrntation such as your Tenancy Agreement, plus photographs of the disrepair, can be sent by email to email@example.com.
Alternatively, you may download the form here and post it to us along with your documentation and photographs.
YOUR TENANCY DETAILS
Tenancy TypePrivate LandlordCouncilHousing Association
Do you have a copy of your Tenancy Agreement?YesI have a copy of my tenancy agreementNoI do not have a copy of my tenancy agreement
Agreement Provided?Yes I will email itYes I will post a copyNo I cannot
Are you in arrears?YesNo
Property TypeFlat / ApartmentTerraced HouseSemi-DetachedDetachedBungalowMobile Home
How many rooms does this affect?123456 or more
Have you reported this to your Landlord?YesNo
Has your landlord responded to your request?YesNo
Do you have a copy of your landlord’s response?YesNo
How many times have you reported the defect(s) to your landlord?1234More than 4 times
Can you provide a list of dates and correspondence?YesNo
Has your health been affected?YesNo
Are other family members affected?YesNo
Have you/they sought medical attention?YesNo
Thank you for the information provided.
After you have submitted this form, please email us any supporting documentation along with photographs of the defects.
Our legal team will then work to validate your claim.
0 + 4 = ? Please prove that you are human by solving the equation *
We are here to help you to get the repairs you require and the compensation you deserve - all on a No Win, No Fee basis!
161 Mowbray Drive
Lancashire FY3 7UN
Tel: 0333 335 0078