Application for the Grant Or Renewal of a Licence

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STIRLING COUNCIL

The Housing (Scotland) ACT 2006

APPLICATION FOR THE GRANT OR RENEWAL OF A LICENCE

FOR A HOUSE IN MULTIPLE OCCUPATION (HMO)

All Fields are Mandatory To be completed in BLOCK CAPITALS *Delete where appropriate

1.Application

(a) / Is the application for Grant or Renewal? /

*GRANT / RENEWAL

(b) / HMO Application property address

To be completed by the owners if a natural person - if owners are not a natural person (e.g. a company or partnership) ignore and skip to Section 3

(a) / Full name
(Owners = everyone on the title deeds for the property)
Use separate sheet if necessary / First and Middle Names / Surname / Maiden Name
(b) / Home Address (of all owners)
Use separate sheet if necessary
(c) / Daytime Tel no.
(of all owners)
Use separate sheet if necessary
(d) / Email (of all owners)
Use separate sheet if necessary
(e) / Date and place of birth (of all owners)
Use separate sheet if necessary /

Name

Date of Birth

Place/Town of Birth (Country also, if not UK)

f) / Is the applicant to carry out the day to day management of the activity?
If NO, give the full name, address, telephone number, email address, age, date of birth and place of birth of the employee or agent acting on their behalf. / *YES/NO
Agent/employees details:-
Name: Age:
Address: Date of Birth:
Place of Birth:
Telephone Number:
Email Address:

To be completed by the owners if not a natural person (e.g. a company or partnership)

(a) / Full Trading Name
(b) / Address of Registered/Principal Office
(c) / Daytime Tel no.
(d) / Mobile Number for Lead Owner
(e) / Full names, private addresses, age, dates and places of birth of all directors, partners or other persons responsible for the management of the business
(f) / Full name, address, telephone number, email address, age, date and place of birth of employee or agent to carry on the day to day management of the activity / Agent/employees details:-
Name: Age:
Address: Date of Birth:
Place of Birth:
Telephone Number:
Email Address:

Landlord Registration

(a) / Are the owners a Registered Landlord with Stirling Council?
If YES, give Registration Number (of all owners)
Use separate sheet if necessary / *YES/NO
Registration Number:
(b) / Is the employee/agent a Registered Landlord with Stirling Council?
If YES, give Registration Number / *YES/NO
Registration Number:

The Premises

(a) / Does the landlord/agent/manager live on the premises?
If YES, what is the number of people in the landlord/agent/manager’s family (including the landlord) living on the premises? / *YES/NO
(b) / Does the landlord/agent/manager and/or his/her family share any facilities with the other residents of the premises?
If YES, please specify what facilities are shared. / *YES/NO
(c) / Maximum number of people to be accommodated on the premises (include landlord/agent/manager’s family) for the duration of the licence
(New licences are granted for maximum of 2 yrs from 1st of April 2014)
(d) / Total number of bedrooms used for

1 occupant
2 occupants
more than 2 occupants

/ TOTAL number of bedrooms =
No of bedrooms having 1 occupant =

No of bedrooms having 2 occupants =

No of bedrooms having more than 2 =
(e) / Give details of the use of each room other than bedrooms (continue on separate sheet of paper if necessary
(f) / Give details and location of facilities provided for cooking, include the number of sinks, fridges and cookers (continue on separate sheet of paper if necessary
(g) / Give the number of bath/shower rooms and list the number of baths/showers, WCs and wash hand basins provided in each (continue on separate sheet of paper if necessary)
(h) / Specify the number of storeys in the premises and the height of each storey from ground level (if property on slope, give heights for each elevation)

Tenancy

(a) / Is a standard lease or other form of tenancy agreement used at the premises?
If YES, please provide a copy with the application
If NO, please explain why there is no tenancy agreement
Has a copy of the Tenancy Information Pack been supplied to the tenants?
If Yes, include a copy of the Tenancy Information Pack / *YES/NO
*YES/NO

Inventory

Is an inventory of furnishings etc provided and agreed with tenant/occupant?
If YES, please provide a copy with the application / *YES/NO

Deposit

Is a deposit required?
Which Tenancy Deposit Protection Scheme holds the deposit? / *YES/NO

Is gas used for cooking or heating purposes in the premises?
If YES, include a copy of the current gas safety certificate with the application / *YES/NO

Electric

Please include a copy of the current electrical safety/ Periodic Inspection Report (P.I.R)
Does the property contain Portable Appliances?
If YES, include a copy of the current Portable Applicant Test (P.A.T) Report / *YES/NO

Does the property have an Energy Performance Certificate (EPC)?
If Yes, include a copy of the current EPC / *YES/NO

Convictions

Subject to the provisions of the Rehabilitation of Offenders Act 1974, state below particulars of any convictions, conditional offers and/or fixed penalties, spent or otherwise, recorded against any person named in Section 2 and 3 above, including any recorded against the company (continue on separate sheet if necessary). Police report will be requested by the Council to verify the information provided. Please state NONE if you have no convictions.
Name / Date / Court / Offence / Sentence

HMO Licences

(a) Has any person named in Section 2 and 3 above previously held or do they currently hold a House in Multiple Occupation Licence?
If yes, which authority gave the licence?
When was it granted?
When did/does it expire?
(b) Has any person named in Section 2 and 3 above ever applied for and been refused a House in Multiple Occupation Licence?
If YES, which authority refused the licence?
When was it refused? / *YES/NO
*YES/NO

Insurance

(a) Is comprehensive Buildings Insurance provided?
(b) Is Property Owner’s Liability Insurance provided? / *YES/NO Amount of cover £
*YES/NO Amount of cover £

Declaration

I/We declare

*(A)that I/we shall, for a period of 21 days commencing with the date hereof, display at or near the premises so that it can be conveniently read by the public, a notice containing such information as required by paragraph 2(3) of Schedule 4 to the Housing (Scotland) Act 2006

*(B)that I am/we are not required to display a notice as the application is in respect of premises to be used as a women’s refuge.

(C)that the particulars given by me/us on this form are correct to the best of my/our knowledge and belief.

I/we enclose £ in payment of the appropriate fee and hereby make application to Stirling Council for the *grant/renewal of the licence applied for.

(D)that I/we have read the attached guidance notes.

Date ………………………..Signature of applicant or agent……………………………..

Agent’s address………………………………

……………………………...

………………………………

Position of applicant in Company/

Partnership if not otherwise stated …………………………….

N.B.Any person who in or in connection with the making of this application makes any statement which he knows to be false or recklessly makes any statement which is false in a material particular shall be guilty of an offence and liable on summary conviction, to a fine.

Information supplied on this form may be held on computer and applicants are advised that in processing this application background enquiries will be made (including a check of Police records) which may include reference to personal data held on computer.

*Delete as appropriate. Where declaration (A) is made there must be produced in due course a Certificate of Compliance with paragraph 2(2) of Schedule 4 to the Housing (Scotland) Act 2006.

Application to be lodged at Stirling Council, Housing & Customer Services, Private Rented Housing Team, Allan Water House, Stirling, FK7 7TEwith the appropriate fee. If, after receipt of the application form it is determined that the relevant fee has not been properly paid, this application will be rendered void.

Please check you have enclosed all of the items to be provided with the HMO application form. There is a checklist provided overleaf, detailing all of the items required to support the application.

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