The Assured Tenancies and Agricultural Occupancies (Forms) Regulations 1997 No. 194

SCHEDULEE+W FORMS PRESCRIBED FOR THE PURPOSES OF PART I OF THE HOUSING ACT 1988

FORM No. 2E+W

Housing Act 1988 section 6(3)

Application referring a Notice proposing different terms for a Statutory Periodic Tenancy to a Rent Assessment CommitteeE+W

•Please write clearly in black ink.

•Please tick boxes where appropriate and cross out text marked with an asterisk (*) that does not apply.

•This form should be used by a landlord or a tenant who has been served with a notice under section 6(2) of the Housing Act 1988, varying the terms of a statutory

periodic tenancy which arises when a fixed term of an assured tenancy, an assured shorthold tenancy or an assured agricultural occupancy ends.

•When you have completed the form, please send it to your local rent assessment panel with a copy of the notice served on you proposing the new terms of the statutory periodic tenancy.

1. Name(s) of tenant(s):E+W

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2. Address of premises to which the tenancy relates:E+W

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3. Name(s) of landlord(s)/agent*:E+W

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Address of landlord(s)/agent*:

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4. Details of premises.E+W

(a)What type of accommodation is rented?

Room(s)□	Flat□	Terraced House□
Semi-Detached House□	Fully Detached House□	Other□(Please specify)

(b)If it is a flat or room(s) what floor(s) is it on?

Ground□ First□ Second□ Other□(Please specify)

(c)Give the number and type of rooms, eg living room, bathroom etc.

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(d)Does the tenancy include any other facilities, eg garden, garage or other separate building or land?

Yes□ No□

(e)If yes, please give details:

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(f)Is any of the accommodation shared with:

(i)the landlord?	Yes□	No□
(ii)another tenant or tenants?	Yes□	No□

(g)If yes, please give details:

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5. When did the statutory periodic tenancy begin?E+W

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6. Services.E+W

(a)Are any services provided under the tenancy (eg cleaning, lighting, heating, hot water or gardening etc.)?

Yes□ No□

(b)If yes, please give details:

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(c)Is a separate charge made for services, maintenance, repairs, landlords’ costs of management or any other item?

Yes□ No□

(d)If yes, what charge is payable?	£....................	per ....................
	(e.g. week, month, year)
(e)Does the charge vary according to the relevant costs?	Yes□	No□

(f)If yes, please give details:

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7.—(a) Is any furniture provided under the tenancy?E+W

Yes□ No□

(b)If yes, please give details. Continue on a separate sheet if necessary or provide a copy of the inventory.

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8. What repairs are the responsibility of:E+W

(a)the landlord? Continue on a separate sheet if necessary.

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(b)the tenant? Continue on a separate sheet if necessary.

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9. Give details (if known) of the other terms of the tenancy, e.g. can you assign the tenancy (pass it on to someone else) and if so is a premium (a payment which is in addition to rent and equivalent to more than two months rent) payable on an assignment? Continue on a separate sheet if necessary.E+W

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10.—(a) Is there a written tenancy agreement? Yes□ No□E+W

(b)If yes, please attach the tenancy agreement (with a note of any variations). It will be returned to you as soon as possible.

11.—(a) I/We* attach a copy of the notice proposing changes to the statutory periodic tenancy and, if applicable, an adjustment of the amount of rent and apply for it to be considered by the rent assessment committee.E+W

Signed ....................

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Date ....................

To be signed and dated by the landlord or his agent (someone acting for him) or the tenant or his agent. If there are joint landlords or joint tenants each landlord/tenant or the agent must sign unless one signs on behalf of the rest with their agreement.

Please specify whether: landlord□ landlord’s agent□ tenant□ tenant’s agent□

(b)Name and address of landlord or tenant referring to the rent assessment committee.

Name(s) (Block Capitals) ....................

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Address

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Telephone—Daytime....................