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Chichester and Arun Landlord Accreditation Scheme Application Form Landlord by Yearoveryear


									Chichester and Arun
Landlord Accreditation Scheme
Application Form
Landlord Accreditation Application Form
 Please complete the form using BLOCK CAPITALS. All applications, whether in
 Chichester or Arun, should be sent to:

                             Chichester District Council,
                           Environmental Health Housing,
                          East Pallant House, 1 East Pallant,
                          Chichester, West Sussex PO19 1TY

First Application                         Renewal

Applicant Details (the applicant must be the owner)

 Full Name (Mr/Mrs/Ms):


                                                         Post Code:

 Home Tel No:                                 Work Tel No:

 Mobile Tel No:                               Fax No:

 Email Address:

Details of the Manager/Agent/Person responsible for management

 Full Name (Mr/Mrs/Ms):


                                                         Post Code:

 Home Tel No:                                 Work Tel No:

 Mobile Tel No:                               Fax No:

 Email Address:
Premises to be accredited

    All premises in Chichester and Arun Districts must be listed below   House in multiple       No of storeys
                                                                         occupation or house     (including basements,
                                                                         in single occupation?   attics, mezzanine floors
                                                                                                 and commercial premises)

    If more than 8 properties please note details of other premises on an accompanying sheet.

Documents REQUIRED for acceptance on the scheme
(Which should ideally be submitted with your application):-

•     Gas Safety Certificate (if gas present)

•     Periodic Electrical Inspection Report, no more than 5 years old, confirming safety of the electrical

•     Sketch plan of the layout of each floor in the property. The plan must identify the use and location of each
      room and the location of any fire precautions including heat/smoke detectors, control panel, emergency
      lighting and fire doors.

•     A Portable Appliance Testing (PAT) report for all electrical appliances provided by the landlord, no
      more than 5 years old.

Data Protection
The information provided will be held on a computer database registered in accordance with the Data
Protection Act 1998.

In order to offer landlords the maximum benefits from joining the scheme, however, it may be necessary
for the District Council to provide some details to third parties, for example in order that addresses of
properties can be advertised.

Please tick the box if you wish to allow your details to be released
• I do not own any rented houses in Chichester or                     Scheme Standards
  Arun Districts other than those listed.
I have no unspent convictions in respect of:                          • I confirm that I have read and understood the
                                                                        Scheme Standards and I agree to bring all the
• Any offence involving fraud or other dishonesty, or                   premises listed up to those standards in a
  violence or drugs or any offence listed in Schedule 3                 timescale agreed with the Council.
  to the Sexual Offences Act 2003.
• Any unlawful discrimination on grounds of sex,                      Furniture Safety Declaration
  colour, race, ethnic or national origins or disability
  in, or in connection with, the carrying on of any                   • I declare that to the best of my knowledge,
  business; and                                                         information and belief, all the furniture and
                                                                        furnishings which have been provided at the
• Contravention of any provision of the law relating to
                                                                        premises listed comply with the current Furniture
  housing or of landlord and tenant law; (including
                                                                        and Furnishings (Fire) (Safety) Regulations and all
  any civil proceedings that you have lost).
                                                                        other statutory safety requirements.
• I have not acted in contravention of any Approved
                                                                      • I will ensure that any furniture which is provided to
  Code of Practice (Acop) in relation to the
                                                                        these premises will comply with these Regulations
  management of HMOs.
                                                                        and requirements.
• No property in my control has been the subject of
                                                                      • I will take all reasonable steps to ensure that the
  any proceedings by a local authority (such as
                                                                        tenants are aware that any furniture and furnishings
  breaches of the Environmental Protection Act 1990,
                                                                        provided by themselves must also comply with the
  planning control, compulsory purchase proceedings
                                                                        above mentioned Regulations.
  or fire safety requirements).
                                                                      • I declare that the information contained in this
                                                                        application is correct to the best of my knowledge.
Management Code
• I confirm that I have read and understood the
  Code of Good Management and I agree to abide
  by the terms of the Code.

 Signed:                                                                     Date:

 Print Name:

        If you have any queries about applying for accreditation please telephone
                 01243 534620 or email

                                         Printed on 100% recycled paper. Please recycle after use.

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