2. What is your relationship to your landlord? Related or friend? NB: Related, includes by marriage, but also step/half/ and ex. If a friend, give details:
3. Does your landlord live in the property with you?
4. What date did you move into the property?
5. What date does your tenancy begin?
6. How do you plan to live at the property / long is your tenancy for?
7. Do you have, or have you ever had any financial interest in the property?
8. Have you or your partner ever stayed at the property? If yes, was this before the tenancy was signed?
9. If yes, please provide details? Was rent charged? If no rent was charged, please state the reasons why.
10. Has your landlord rented out this property before? If yes, who to and how much rent was being charged at that time (if known)?
11. If you left, would it be rented out again?
12. Did you look for or at any other properties before taking on this tenancy? If yes, please provide details:
13. How did you become aware that this property was available?
14. Was the property purchased to rent to you?
15. What was your previous address?
16. Were you liable to pay rent at your previous address?
17. What was your reason for leaving your previous address?
18. Have you claimed Universal Credit/ Housing Benefit before? If so, for what address?
19. What action would your landlord take if you failed to pay any rent
20. What action would your landlord take if you did not pay the full rent?
21. How was the rent of £ a month reached?
22. Do you have a tenancy agreement?
23. Have you paid a deposit and is it held with the tenancy deposit scheme? Please provide proof. £
24. Before commencing the tenancy the landlord must provide you with the following: a. How to Rent guide (proof required) b. Mandatory gas and electric check certificates (proof required) c. Smoke and carbon monoxide detectors d. Energy Performance Certificate (proof required) 25. Are you up to date with your rent payments? If yes, please provide evidence of payment?
26. Would your landlord accept less rent at times if you could not afford the full rent?
27. Will your landlord accept a lower rent if Universal Credit does not meet your full rent liability?
28. Would your landlord take you to court to evict you, if you failed to pay the rent?
29. Would your landlord take legal action to recover rent arrears?
30. Are you in arrears with your rent? If yes, how much and what action has your landlord taken to recover the arrears?
I/We declare the information I/We have given on this form is correct and complete to the best of my/our knowledge. I/We understand if I/We give incorrect or incomplete information or fail to report any changes that might affect my/our benefit, I/We may be prosecuted. I/We know to tell the DWP immediately of any changes that may affect the amount of benefit I/We receive. I/We know and accept if we do not report any changes affecting our benefit, or I/We give incorrect or incomplete information, I/We must repay any resulting overpayment. I/We accept that the DWP may prosecute any person who gives incorrect, incomplete or misleading information to fraudulently obtain benefit.
Signed by Claimant:…………………………...…… Date …………… Signed by Interviewing Officer: ……………………………… Date:………… Print Name: ………………………………………….