The Licensing and Management of Houses in Multiple Occupation and Other Houses (Miscellaneous Provisions) (Wales) Regulations 2006

4.  The form of declaration mentioned in regulation 7(3)(a) is as follows—

  • I/we declare that the information contained in this application is correct to the best of my/our knowledge. I/We understand that I/we commit an offence if I/we supply any information to a local housing authority in connection with any of their functions under any of Parts 1 to 4 of the Housing Act 2004 that is false or misleading and which I/we know is false or misleading or am/are are reckless as to whether it is false or misleading.

  • Signed (all applicants)

  • Dated

  • I/We declare that I/We have served a notice of this application on the following persons who are the only persons known to me/us who are required to be informed that I/we have made this application:

    NameAddressDescription of the person’s interest in the property or the applicationDate of service