Part 2: Houses in Multiple Occupation

Housing Act 2004

Part 2: Houses in Multiple Occupation

Mandatory Licensing

Renewal Application Form

For admin use only:
Date Issued:
Date Received:
Reference:

Please contact us if you need any assistance

filling in the form.

Please be aware that your details will be added to a public register of licensed houses in multiple occupation within Cornwall as required by the Housing Act 2004 on granting a HMO licence. This register is available to view on Cornwall Council’s website.

Please complete the following:(Fill in this form in blue or black ink and please write clearly or print)

PART 1APPLICANTS INFORMATION

PART 2MANAGEMENT ARRANGEMENTS

PART 3DETAILS OFPROPERTY

PART 4 DETAILS OF AMENITIES

PART 5DECLARATIONS

All of the following must be submitted (where required) for your application to be deemed valid

Checklist:

□Completed and signed application form
□Detailed Floor Plan with room names and sizes □Licence Fee - £365
□Copy of Landlords Annual Gas Safety Certificate (if applicable)
□Copy of Electrical Installation Condition Report/Periodic Inspection and Testing Certificate
□ Copy of Annual Fire Detection and Alarm System Testing Certificate (Required for Grade A and Grade D Fire Detection Systems)
□ Copy of Routine Testing Log (Required for Grade A and Grade D Fire Detection Systems)
□Copy of Annual Fire Extinguisher Test Certificate (where applicable)
□Copy of Annual Emergency lighting Test Certificate (where applicable)
□Copy of Annual Portable Appliance Testing certificate

PART 1: APPLICANTS INFORMATION

Will the applicant be the proposed licence holder?Yes No

Please state whether you are applying for an HMO licence as:

An individual a limited company a partnership a trust

Address of property to be licensed: (One application per property)

……………………………………………………………………………………… Postcode ………………………………………

Name & address of applicant:…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Tel: ……………………………………………… Mobile: ……………………………

Email: ………………………………………………………………………………… Date of Birth: ………………

Name & address of owner(s) of property if different from applicant. Please specify whether leaseholder or freeholder (please use a separate sheet if necessary)

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Tel: ……………………….. Email: ……………………………………………………………………………………………

If the applicant is a company, partnership, or trust, please complete the attached information in Appendix 1 of this application

Name and address of mortgage company (all details must be provided):

…………………………………………………………………………………………………………………………………………………

……………………………………………………………… Mortgage account number: …………………………………

Fit & proper person – the words belowhave been taken directly from the regulations within Statutory Instrument 2006 No.373 and are a fundamental requirement of this application. The mention of ‘the Act’ refers to the Housing Act 2004.

The local authority must consider evidence whether the proposed licence holder, and any person associated or formerly associated with them, whether on a personal, work or other basis is a fit and proper person.

Statement: / Yes / No
Please indicate if there has been any unspent convictions that may be relevant to the proposed licence holder’s fitness to hold a licence and in particular any such conviction in respect of any offence involving fraud, dishonesty, violence, drugs or Sexual Offences Act 2003: Schedule 3 (a)
Please indicate if there has been any finding by a court or tribunal against the proposed licence holder or manager that he/she has practised unlawful discrimination on the grounds of sex, colour, race, ethnic or national origins or disability in or in connection with, the carrying on of any business.
Please indicate if there has been any contravention on the part of the proposed licence holder or manager of any provision of any enactment relating to housing, public health, environmental health or landlord and tenant law which led to civil or criminal proceedings resulting in a judgement being made against him.
Please indicate if there has been any information, about any HMO or house the proposed licence holder owns or manages, which has been the subject of a control order under section 379 of the Housing Act 1985 (a) in the five years preceding the date of the application or any appropriate enforcement action as described in section 5 (2) of the Act
Please indicate if there has been any HMO or house the proposed licence holder owns or manages that has been the subject of an interim or final management order under the Act.
Please indicate if there has been any HMO or house the proposed licence holder owns or manages for which a local housing authority has refused to grant a licence under Part 2 or 3 of the Act:

We may require your co-operation to confirm the information we obtain. We may also have to share/and or check information with other authorities, such as the Police, Fire & Rescue Service, Office of Fair Trading, Inland Revenue etc. Signing of this application will be taken as your agreement to any such action.

Are you a member of any landlords association or other professional body?

Yes □No□ Please indicate which: ……………………………………………………………

Membership Number ……………………………………………………………

Please confirm that your building is adequately insured:Yes□No□

Please list other HMOs/houses in a) this local authority area b) other local authority area. (Please use separate sheet if necessary)

Do you hold any professional qualifications relevant to your application? Please indicate which:

……………………………………………………………………………………………………………………………

Are you on any accommodation lists for any academic or other organisation/institution? Please state which.

……………………………………………………………………………………………………………………………………………………………………………………………………………

Please list any training courses you have undertaken or conferences attended in the last 3 years which you feel make you a better landlord.

PART 2: MANAGEMENT ARRANGEMENTS

Name and address of person managing the property

…………………………………………………………………………………………………………………………………………………

Tel: ………………………………………Email: ………………………………………………………………………

2. Is the manager to be the licence holder? …………………………………………………………

Professional qualifications such as RICS, ARMA, ARLA, etc.

………………………………………………………Membership Number:……………………………………………

Does the manager have professional indemnity insurance?Yes□No□

Does the manager have a procedure for dealing with complaints? Yes□No□

Please provide details regarding the management arrangements for the property. This should demonstrate competency of any individuals involved in its management, areas of responsibility, proposed visit frequencies, maintenance, inspection/testing programmes, access arrangements for Local Authority Officers and spend authorisations/funding arrangements:

5. Name & full address of any manager/rent collector/ other person having control of the property (please indicate)

…………………………………………………………………………………………………………………………………………………

Tel: ……………………………………………….. Email: ……………………………………………………………………………

Company/partnership/trust information: including Registered address or principal trading address where appropriate (where different from above)

Tel: ………………………………….………………….. Email: …………………………………………………………………….

Fit & proper person – the words and details used in section 5.1 – 5.6 have been taken directly from the regulations within the Statutory Instrument 2006 No.373 and are a fundamental requirement of this application. The mention of ‘the Act’ refers to 2004 Housing Act.

The local authority must consider evidence whether the proposed licence holder, and any person associated or formerly associated with them, whether on a personal, work or other basis is a fit and proper person.

8. Please indicate number of individual properties you manage: …………………………………….

PART 3: PROPERTY DETAILS

Fire Precautions

a)Is there a automatic fire detection system installed in the property: / Yes / No
- A fire alarm panel / Yes / No
- Emergency lighting covering the escape route / Yes / No
- Smoke/heat detectors in kitchen/common rooms / Yes / No
- Smoke detectors covering the hallways and landings / Yes / No
- Sounders/alarms on all levels / Yes / No
- Call points on the hallways and next to exit doors / Yes / No
- Fire blankets in all kitchens / Yes / No
- Fire extinguishers on all hallways and landings / Yes / No

b)Are all the doors opening onto the main escape route 30 minute fire resistant doors incorporating self-closers? Yes No

c) Are these doors fitted with smoke seals and intumescent strips? YesNo

d)Is the escape route kept clear of flammable material and other obstructions?Yes □ No □

e)Do you have a contractor/s to maintain and inspect your Fire Precautions?Yes □ No □

Please state the contractor: …………………………………………………………………………

f) Is there a log book of inspection/testing? Yes□No□

g) Where is it kept? ………………………………………………………………………………………………….

Have the occupants been given details of fire escape routes and fire safety training?Yes□ No □

Has a competent person carried out a Fire Risk Assessment of the Property? (not required in “shared” type HMO properties)Yes □No □(Please provide a copy)

Heating & Insulation

a) What form of heating does the property have?

Gas fired central heating / Yes / No
Off peak night storage heaters / Yes / No
Individual wall mounted gas heaters / Yes / No
Individual wall mounted electric heaters / Yes / No
Other (please specify if there is no fixed heating system):
………………………………………………………………………………………………………………………
Heating System Coverage:
Bedrooms / Yes / No
Washing Facilities / Yes / No
Hallways / Yes / No
Communal Living Room / Yes / No
Kitchen / Yes / No

Please give details of where fixed programmable heating is not provided in the property:

……………………………………………………………………………………………………………………

Is the loft insulated? Date if known: ……………………………………. / Yes / No
If there are cavity walls, do you have cavity wall insulation? / Yes / No
Are the windows: In good repair? / Yes / No
Double glazed? / Yes / No
Does the property have a carbon monoxide detector / Yes / No

b)If there are gas appliances, please confirm that you have a current Landlords Gas Safety Certificate (required annually for the installation and equipment you provide) and provide a copy. Yes□No□

c)Please confirm that you have an electrical installation condition report from a NICEIC approved or equivalent electrical engineer or for new build properties a commissioning certificatePlease attach themost recent copy Yes□No□

Please indicate date of any major work to the electrical installations.
Date: ………………………………………………………………………………………………………………………

d) Please confirm whether or not you provide portable electric appliances such as irons, toasters and fridges for use by tenants Yes□No□

Please attach themost recent copy of PAT test certificate

11. Electrical Appliances and Furniture

Please indicate whether you provide:

Furniture / Yes / No
Appliances (e.g. kitchen equipment, heater, vacuum cleaner) / Yes / No
Is all furniture compliant with current fire safety regulations? / Yes / No
Are all the appliances compliant with current electrical safety regulations? / Yes / No
Please forward a copy of your latest Portable Appliance Testing (PAT) certificate.

12. Tenancy Management

Please confirm whether you provide the following:

Tenancy agreements/written details of terms of tenancy, including sanctions for anti social behaviour? / Yes / No
If you use a standard form of tenancy agreement, please provide a copy
Inventory & schedule of condition at commencement of occupancy / Yes / No
Rent book/receipts / Yes / No
Repairs contact/procedure / Yes / No
Complaints procedure / Yes / No

Any further information you feel will help to demonstrate your management skills?

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

PART 4: AMENITY DETAILS

Please remember to provide a detailed floor plan of the property including room size measurements (see guidance sent with this application)

Type of facility / Location (Please circle floors below) / Number (Total)
Bath/shower / Basement / Ground / 1st / 2nd / 3rd / 4th
Wash hand basin / Basement / Ground / 1st / 2nd / 3rd / 4th
W.C / Basement / Ground / 1st / 2nd / 3rd / 4th
Cooker / Basement / Ground / 1st / 2nd / 3rd / 4th
Combination Microwave / Basement / Ground / 1st / 2nd / 3rd / 4th
Sink & Drainer / Basement / Ground / 1st / 2nd / 3rd / 4th
Fridges / Basement / Ground / 1st / 2nd / 3rd / 4th
Freezers / Basement / Ground / 1st / 2nd / 3rd / 4th
Combined Fridge Freezers / Basement / Ground / 1st / 2nd / 3rd / 4th
Food storage cupboards / Basement / Ground / 1st / 2nd / 3rd / 4th
No. of sleeping rooms (bedrooms): / Number of households (unrelated persons):
No. of people occupying the HMO:

Any other details of facilities which you consider relevant to your application:

PART 5: DECLARATIONS

DECLARATION

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 reckless as to whether it is false or misleading.

Signed: ………………………………………………………… Date: ………………………………………………………

Name: (please print) ………………………………………………………………………………………………………..

Signed: ………………………………………………………… Date: ………………………………………………………

Name: (please print) ………………………………………………………………………………………………………..

DECLARATION

I/We declare that the house in respect of which a licence is sought under Part2/Part 3 of the Housing Act 2004 is subject to a licence under that Part at the time this application is made. I/We further declare that to the best of my/our knowledge either: (a) none of the information described in paragraph 2(c) to (g) of that Act and previously submitted to the authority has materially changed since that licence was granted; or (b) the only material changes to that information are described as follows: [include description of all material changes].”

Signed: ………………………………………………………… Date: ………………………………………………………

Name: (please print) ………………………………………………………………………………………………………..

Signed: ………………………………………………………… Date: ………………………………………………………

Name: (please print) ………………………………………………………………………………………………………..

IMPORTANT INFORMATION
You must let certain persons know in writing that you have made this application or give them a copy of it. The persons who need to know about it are:

Any mortgagee of the property to be licensed
Any owner of the property to which the application relates (if that is not you) i.e. the freeholder and any head lessors who are known to you
Any other person who is a tenant or long leaseholder of the property or any part of it (including any flat) who is known to you other than a statutory tenant or other tenant whose lease or tenancy is for less than three years (including a periodic tenancy)
The proposed licence holder (if that is not you)
The proposed managing agent (if any) (if that is not you)
Any person who has agreed that he/she will be bound by any conditions in a licence if it is granted.

You must tell each of these persons:

Your name, address, telephone number and e-mail address or fax number (if any)
The name, address, telephone number and e-mail address or fax number (if any) of the proposed licence holder (if it will not be you)
Whether this is an application for an HMO licence under Part 2 or for a house licence under Part 3 of the Housing Act 2004
The address of the property to which the application relates
The name and address of the local housing authority to which the application will be made
The date the application will be submitted

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 that are required to be informed that I/We have made this application:
Signed: ………………………………………………………… Date: ………………………………………………………
Name: (please print) ………………………………………………………………………………………………………..
Signed: ………………………………………………………… Date: ………………………………………………………
Name: (please print) ………………………………………………………………………………………………………..

Appendix 1 – Details of companies, partnerships and trustees

Company/partnership/trust information: including registered address or principal trading address

where appropriate: …………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………

Tel: ……………………………………………… Email: …………………………………………………………………………

Names, contact details and signature of all directors/partners/trustees (please use a separate sheet if necessary)

Name:…………………………………………………… Signed:……………………………………………………Tel: ……………………………………………….. Email: ……………………………………………………………(Director/Partner/Trustee)

Name & address of Company Secretary

Tel: ……………………………………………….. Email: …………………………………………………………………………

Details of relevant professional qualifications such as RICS, ARMA, ARLA, etc (please use a separate sheet if necessary) Pre-printed information about your organisation is acceptable, validated by the signature of the appropriate officer. (Where different from above)……………………………………………………………………………………………………………………………………………………….………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Tel: ……………………….…………………………….. Email: ……………………………………………………………………

Cornwall Council HMO App 2012page 1 of 16