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Please use the form below and tell us about your Housing Disrepair. Please try to provide us with as much information as possible to help with the assessment of your claim.

If you do not know an answer to a question or a certain date then just give a rough estimate.

Personal Details

Title

Full Name

Reference Number

Street Address

Street Address Line 2

City

Postcode

Phone/Mobile

DOB

Occupation

National Insurance Number

Qualification and Client History

When did your tenancy start?

How much is rent on the property?

How much are the arrears currently?

When was the first time you reported the issues?

What did you report at the time?

When was the MOST RECENT time you reported problems in your home to the landlord?

When was the last time a representative of your landlord visited your property for any reason?

What was the purpose of that visit?

How many times have you reported in total?

What rooms in your house are affected by disrepair?

Name of joint tenant

Occupation reasons?

Disrepair Details - Please describe the disrepair of each room in detail as this can benefit your claim.

Description of damage and effect on occupants

Additional Questions - Please provide additional detail if necessary.

What rooms do you have in your home?

What type of windows do you have in the property?

Injuries and Health Affected

If yes, who was affected?

When did this injury occur?

If so, what was the advice given and where?

I hereby acknowledge HD Claimants will use the information provided in this form to assist with my claim, my information may be passed onto trusted partners who may contant me to further process the claim .View terms of use

Thanks for submitting!

Photo/Video Evidence

IMPORTANT: Photo/Video Evidence - Please provide as many images/videos of the damage in your home. We require clear closeup and distant evidence.

Please can you send all images to info@hdclaimants.com along with your full name, alternatively you can send your images via Whatsapp at 07943724118.