APPLICATION FOR SECRETARY OF STATE'S CONSENT TO DISPOSAL OF LAND OR PROPERTY UNDER SECTION 133 OF THE HOUSING ACT 1988

(Please continue on an additional sheet, or expand in a covering letter, if necessary)

1. Applicant's name and address:-

2. Location/description of land/property (please attach a site plan):-

3. Please confirm that the current owner acquired the land or property by virtue of a consent granted under section 32 or 43 of the Housing Act 1985:-

4. The land/property is tenanted/vacant (please delete whichever is inappropriate).

5. If tenanted, please provide evidence that appropriate steps have been taken to consult tenants (section 133 (5)):-

6. Please confirm that the proposed disposal will not conflict with any assurances given to tenants as part of any consultation prior to the previous disposal under section 32 or 43 of the Housing Act 1985:-

7. Disposal will be to:-

8. The disposal will be freehold/leasehold (If leasehold please give details):-

9. Are there any covenants or restrictions imposed on the use of the land/property? (If so, give details):-

10. Please give any information you may have about the extent to which the disposal might be to a body under local authority control:-

11. Reasons for disposal and application of proceeds:-

12. Selling price (if value is £5000 or more, please also attach a DV's or independent valuer's valuation of no more than three months old. Please note that an estate agent’s offer price is not sufficient.): -

13. Please advise whether consent is also required under section 171D(2) of the Housing Act 1985 to dispose of less than the landlord’s whole interest in any dwelling-house, or in part of it. Please supply a copy of the section 171D restriction as entered in the register by the Land Registry.

14. Please confirm that the disposal is not covered by the General Consents under section 133 of the Housing Act 1988 and section 171D of the Housing Act 1985 issued on 21 March 2005 to Chief Executives of all Housing Associations, and please explain why it is not covered:-

15. I certify that the information on this form is correct and that the disposal has been authorised specifically by (or under formal delegated authority from) the management committee/trustees of the disposing body and (if applicable) is not to any person or business specified in Schedule 1 to the Housing Act 1996 or does not contravene general charitable law. I am not aware of any other information which might materially affect the Secretary of State's consideration of this application.

Signature

Please print name

Position Date

Please return the completed form and any enclosures to Ann Hinds, Andrea Gibbs or Jo Thorpe, Decent Homes Division 3, Department for Communities and Local Government, 2nd Floor, Zone D/2 Eland House, Bressenden Place, London, SW1E 5DU