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1. The particulars specified for the purposes of article 2(3) are set out in paragraphs 2 to 11 below.
2. The address of the dwelling of which insurance is the subject of the application and, where the dwelling is not a house and forms part of a building, the address of the building.
3. A statement setting out the dispute which is the subject of the application including—
(a)whether it is alleged by the applicant that the insurance which is available from the nominated insurer for insuring the tenant’s dwelling is unsatisfactory in any respect and, if so, in what respect,
(b)whether it is alleged by the applicant that the premiums in respect of any such insurance are excessive and, if so, in what respect,
(c)the amount of the premiums payable in respect of the insurance available from the nominated insurer,
(d)the cover provided by the insurance policy, and
(e)the period to which the insurance is attributable.
4. The name and address of the applicant and the name, address and occupation of the applicant’s representative, if any.
5. The name and address of the respondent landlord and, if that address is not in England and Wales, an address in England and Wales at which notices may be served (if known to the applicant).
6. Where the dwelling forms part of a building which contains other dwellings, the name and address of every tenant or other person within that building who is known to the applicant who is or may be required to pay for or contribute to the costs of the same or substantially the same insurance and, where a recognised tenants' association exists in respect of the building, the name and address of the secretary of the association.
7. A copy of the lease under which the tenant is required to insure the dwelling with an insurer nominated by the landlord.
8. A copy of the insurance policy if this is within the possession of the applicant or can reasonably be obtained by the applicant.
9. The matters upon which the applicant intends to rely in support of his application; and where he intends to rely on any document, a copy of that document.
10. Whether the applicant claims a reduction or waiver of fees and, if so, the basis of the claim.
11. The date of the application.
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