Housing Disrepair Claim Form

1. Property & Tenancy

Tell us about your rented property and landlord.

Country *

Landlord type *

CouncilHousing AssociationPrivate LandlordLetting Agent

Council / Housing Association / Landlord name *

Type of property *

Tenancy start date

Tenancy setup

This is a joint tenancy

Number of occupants

2. Your Details

Full name *

Date of birth

Email *

Mobile *

Property address *

Postcode *

Best time to call back

3. Rent Information

Rent paid

Rent amount (£)

Receiving benefits (Housing Benefit / UC)?

Rent arrears?

If arrears, is there a payment plan?

4. Landlord Report History

Have you reported the disrepair to your landlord?

When did the issues start? *

Have you reported it to the landlord?

Yes, I have reported the disrepair

How many times have you reported it?

Has the landlord responded?

Most recent report date

5. Affected Rooms

Add every room affected by damp, mould, leaks, structural or heating issues.

Room 1

Room

Personal property damaged (optional)

Disrepair details

6. Health & Medical

Tick anything that applies. Leave blank if none.

7. Supporting Evidence

Optional but strongly recommended. Photos of damp / mould / leaks, letters to your landlord, repair reports, ID and proof of address all help build a stronger case.

Supporting evidence (optional)

Add up to 10 photos or documents. Max 8MB per file. JPG, PNG, HEIC, PDF, DOC.

No files selected

8. Final Details

Anything else we should know?

Preferred contact method

EitherPhoneEmail

Previous legal advice

I have already spoken to another solicitor about this

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Housing Disrepair, Claim Intake Form