This form does not oblige you to extend your lease.
Please complete this form as fully as possible
* mandatory fields
Account Reference Number: * (what is this?)
Property Description:
Property Address Address Line 1 (what is this?) Address Line 2 Town/City County Postcode
Local Authority Area
Name of Applicant(s) *
Name of Owner(s) (if different to applicant)
Correspondence Address (if different Postcode) Address Line 1 Address Line 2 Town/City County Postcode
Contact Home No.
Contact Daytime No.
Email Address.
Annual Ground Rent
Ratable Value (this will be shown on your Water Rate Demand)
Expiry Date of Lease (if known)
Type of Property (please tick all that apply)
If Flat or Maisonette please give which floor
If Other please give details
Number of Bedrooms
Number of Reception rooms
Value of the Property (estimate)
When did you buy the property?
How long have you lived there?
Are you living there at the moment? Please Select Yes No
Is the property currently on the market? Please Select Yes No
Have you (or any previous owner) made any alterations or extensions to the property? Please Select Yes No
If yes, please list
Has a garage been built at the property since the property was built? Please Select Yes No
If you answered yes to questions 19 or 20, was Freeholder's consent obtained? Please Select Yes No Not Sure
Is the property used for residential purposes only? (i.e. non business premises) Please Select Yes No
I hereby declare that all the information provided is correct to the best of my knowledge *