PRIVATE TENANTS BEING TOLD TO LEAVE

referral to the Tenancy Relations Team

Your details
Your name / Click here to enter text. /
Your address / Click here to enter text. /
Contact phone number / Click here to enter text. /
Who else usually lives with you at your address? / Click here to enter text. /
Landlord’s details
Landlord’s name / Click here to enter text. /
Landlord’s address / Click here to enter text. /
Landlord’s phone number / Click here to enter text. /
Agreement
(click ? for more info)
Is there a written tenancy agreement? / YES ☐NO ☐
If YES, what date did the latest agreement start? / Click here to enter text. /
If YES, what is the end date of the latest agreement? / Click here to enter text. /
If the agreement was verbal, when did you move in? / Click here to enter text. /
How much rent do you pay? / Click here to enter text. /
Is the agreement just between yourself and your landlord? / YES ☐NO ☐
If NO, who else is included on the agreement? / Click here to enter text. /
Accommodation
(click ? for more info)
Do you have to share parts of your flat/house with anyone who is not either a joint tenant or a member of your family? / YES ☐NO ☐
If YES, what rooms are shared? / Click here to enter text. /
How many people are living there? / Click here to enter text. /
How many floors are there? / Click here to enter text. /
Notice to leave
(click ? for more info)
Why do you think your landlord wants you to go? / Click here to enter text. /
Was the Notice in writing or verbal? / Click here to enter text. /
When did you actually receive the Notice?This may not have been the date on the Notice / Click here to enter text. /
How did you receive the Notice?e.g. hand-delivered, first class post / Click here to enter text. /
When have you been asked to leave by? / Click here to enter text. /
Have you given the landlord any notice (in writing or verbal) that you are leaving? / YES ☐NO ☐
Deposit
(click? for more info)
Have you paid a returnable deposit to the landlord? / YES ☐NO ☐
Has the landlord returned your deposit? / YES ☐NO ☐
Has the landlord given you any information telling you how the deposit has been protected, including any leaflets given? / YES ☐NO ☐
Other issues
(click ? for more info)
Have you been harassed by the landlord, or been threatened with locks being changed, possessions being removed or gas/electric being cut off? / YES ☐NO ☐
Are there any other issues with the tenancy you need advice about? / Click here to enter text. /
Contacting the landlord
(click? for more info)
If we think it’s necessary to make sure your landlord is aware of the law, are you happy for us to contact the landlord to explain what your rights are? / YES ☐NO ☐
Do any of the following apply? (click ? for more info)
Are you employed by the landlord? / YES ☐NO ☐
Do you live in the same building as the landlord? / YES ☐NO ☐
Have you rented other accommodation from this landlord apart from where you’re living now? / YES ☐NO ☐
Does the landlord provide services such as cleaning or preparation of meals which involves the landlord going into the house/flat/room? / YES ☐NO ☐
Are you related to, or a close friend of, the landlord? / YES ☐NO ☐
Have you taken over the tenancy from a close relative who has died? / YES ☐NO ☐
Did your tenancy first start before 28 February 1997? / YES ☐NO ☐
Has your landlord provided you with a gas safety certificate in the past 12 months? / YES ☐NO ☐
Are you currently staying in the place you rent? / YES ☐NO ☐
Equalities
(click ? for more info)
What do you consider to be your ethnic origin? / Choose an item.
Gender / Male ☐ Female ☐
Date of birth / Click here to enter text. /
Do you consider yourself to be disabled? / YES ☐NO ☐
If YES, what accessibility requirements do you have? / Choose an item. /

Please note that to advise you further, we will need copies of:

Your Notice

Any letters from your landlord

The latest tenancy agreement you have signed

Any documents you have about the deposit you paid.

If you have these documents with you today, please ask reception or the Housing Solutions Officer you see, to copy them and send them to us.

If you don’t have the documents today, then please:

  • bring them in at a later date
  • email copies to us
  • post copies to us at 1st Floor, Howden House, 1 Union Street, Sheffield, S1 2SH.