EnvH – Report a repair problem with a private landlord

Your Details:

Name(Required)

First Name Last Name

Address(Required)

Street Address Address Line 2 Town Postcode

Your Phone number(Required)

Enter your day time phone number please

Your email address:(Required)

Are you the tenant ?(Required)

Yes

No

Tenant's details

Tenant's name(Required)

First name Last name

Is your address different than the above ?(Required)

Yes

No

Tenant's address if different than above(Required)

Street Address Address Line 2 City Postcode

Further information

Have you informed your landlord of the problem and given them time (min 2 weeks) to repair the problem?(Required)

Yes

No

Can you provide evidence to confirm that you have contacted your landlord (email, txt etc.)?(Required)

Yes

No

Documentary evidence(Required)

Please upload documents here

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB, Max. files: 4.

Is there anyone vulnerable in your home whose health is affected by the problem?(Required)

For example, a baby, old age person, or someone who is sick or disable. We may check this.

Yes

No

Vulnerable person(s) details

Vulnerable person(s) detail(Required)

Please click on (+) button to add more members

Vulnerable person name

Age

How the problem particularly affecting

Your landlord's details

Name of your landlord or managing agent(Required)

Contact address of your landlord or agent(Required)

Street Address Address Line 2 Town Postcode

Your landlord or agent phone number(Required)

Your landlord or agent email address(Required)

The repair problem

What is the problem your landlord won't sort out?(Required)

Any further information

If you would like to add more information then please write here

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Date