Tenants Details
Surname
Fornames
H/B
(Yes/No)
National InsuranceNo
*Failure to supply at least one (N.I No:Or Dob)
NOT being placed on register.
Reasons for entering (tick as appropriate)
NO
YES
(A) Left without giving notice
NO
YES
(B) Left Leaving Furniture/accommodation in dirty condition
NO
YES
(C)
Left owing more than 4 weeks rent
NO
YES
(D) Tampered with
meter
NO
YES
(E) Unsociable behaviour e.g. Loud music,Parties,Dogs/cats
Assaulted landlord or other resident(s),
NO
YES
(F) Stole from these premises (e.g.
landlord's fixtures or fittings)
NO
YES
(G) Damaged property,
value in excess of damage deposit held
NO
YES
(H) Drug user
NO
YES
( I ) Drink problems,causing nuisance to others
NO
YES
( J )
Criminal activities e.g. Suspected of drug dealing, prostitution,
arson,theft/burglary etc.(Both proven and alleged offences
NO
YES
(K) Failed to provide Local Authority with adequate I.D.to verify
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PLEASE
COMPLETE THE FOLLOWING AND SEND THIS FORM
Name
and Address of WLA Member
Your signature:
I certify that
I am responsible for the accuracy of the information provided and that the tenant named above has agreed on the tenancy agreement or separately in writing,
that the information concerning the tenancy may be passed to other landlords or agents.
By submitting this form electronically you are agreeing to the above in lieu of a signature.
N.B.
Members are advised that under the Act "Data Subjects"
(The Tenant) have the right to request details of information held by the "Data Controller"
and may challenge its accuracy
WESTCOUNTRY LANDLORDS ASSOCIATION
P.O.BOX 454
PLYMOUTH PL3 4WL
