RENT BREAKDOWN FORM FOR LANDLORD/AGENT

RENT BREAKDOWN FORM FOR LANDLORD/AGENT
Part A
Claim no:
Personal Details
Full name of tenant(s):
Full postal address of
The property
Part B
Rent details
Start date of tenancy:
Date the tenant moved into the property:
How much rent is the total rent charged? £
Is the rent payable?
Please tick the box that applies.
Weekly
Monthly
Four weekly
Other.
Please state
Fortnightly
Please give a breakdown of the services included in the total rent charged.
Continue on a separate sheet of paper if necessary.
Service
Water rates
Amount included in
total rent charged
Service
Cooking
Heating
Breakfast only
Lighting
Breakfast
& evening meal.
Hot water
Full board
Amount included in total
rent charged
Part C
Continued occupancy of property
I confirm that the above tenant is still living at the above property & their rent remains the same. Please
tick the box.
I confirm that the above tenant is still living at the above property & their rent has increased. Please tick
the box.
The date of the rent increase was………………………..
It has increased to £…………………per…………………week/month/4 weekly
Part D
Details of Landlord
This section must completed
Full name of landlord
Full postal address of
Landlord
Telephone number
Part E
Details of Landlord’s Agent(if applicable)
Full name of Agent
Full postal address of
Agent
Telephone number
Part F
Signature
please sign below
Landlord/Agent
Date