Housing advice form

In order to get advice, please fill in the form below. Please complete ALL parts of the form. If a part of the form does not apply to you or you are unsure of an answer, you must still fill it in with "not applicable" or similar

Your Full Name:
Your Email Address:
Your Postal Address
A Contact Phone Number
When did you move in to your place of residence?
If you are a home owner, is there a mortgage?
If you are renting, who is your landlord and what rent if any is paid?
Does the accommodation come with a job?
Do you have a written agreement, if so whose name is it in?
If you have nothing in writing, what did you agree verbally?
Have you been given anything in writing asking you to leave the accommodation?
What reason(s) has the landlord/lender given?
Do you dispute the reasons?
Are there any rent/mortgage arrears? How many weeks/months?
Any reason for them? (eg delayed housing benefit payments)
Has the landlord (or anyone instructed by them) made the client's life difficult (to try to get them to leave)? eg cutting off gas/electric, changing locks, coming in uninvited, late night visits, racial/sexual abuse of client, threatened client?
Are there any other issues you would like us to know about? If so please give details.
Provide a description of the problem, what has led up to the situation, and what outcome is wanted.