Private Sector Housing
Tenant referral form
Please complete ALL the information required on this form and return it to:
Private Sector Housing
Canterbury District Council
Military Road
Canterbury, CT1 1YW
or email to: [email protected]
About you
Name:
Address:
Phone number:
Email address:
Type of tenancy:
Total rent payable:
Are you in receipt of Housing Benefit?
Are you currently on the Housing Need Register?
How long have you lived at this address?
About your managing agent (where applicable)
Name of managing agent:
Address:
Phone number:
Name of contact person:
Yes
Yes
No
No
About your landlord
Note: You must supply your landlord’s details. Failure to do so may result in this
form being returned to you. You may need to ask your managing agent for this
information.
Name of landlord:
Address:
Phone number:
About your problems
Please outline the problems you are experiencing, for example: no heating, no hot
water, ceiling collapsed, etc:
When did you inform your landlord/managing agent about your problems?
(Please enclose copies of any letters you have sent to your landlord or managing
agent regarding your problems.)
What was their response? (Please enclose copies of any letters you have
received from your landlord or managing agent regarding your problems.)
Need to write to your landlord?
Use this example to help you.
[Your address]
[Your landlord or letting agent’s address]
[Today’s date]
Dear [name of landlord/letting agent]
Request for repairs to be carried out at [your address]
I am writing to let you know that the following repair work needs to be carried out to
the above property which I rent from you.
1. [List the things that are wrong and explain the problems caused, for example:

the boiler is not working so there is no hot water or central heating;

the handle to the bathroom window is broken and the window cannot be
opened].
Please could you contact me on [list home/mobile phone numbers] as soon as
possible to arrange a time for the repair work to be carried out.
Many thanks
Yours sincerely
[Your name]