Housing Solutions

South Derbyshire District Council,

Civic Offices, Civic Way,

Swadlincote, Derbyshire DE11 0AH.

www.southderbyshire.gov.uk

«CustomerTitle» «CustomerFirstName» «CustomerLastName» «CustomerCurrentAddressMultiLine» @SDDC on Twitter

@southderbyshiredc on Facebook

Please ask for Housing Solutions Team

Phone (01283) 595795

Typetalk 18001

DX 23912 Swadlincote

housing.jigsaw@southderbyshire.gov.uk

Ref: «ApplicationId»

«DateToday»

Dear «CustomerTitle» «CustomerLastName»

South Derbyshire Housing Application

Please find enclosed a Landlord Reference Form. You will need to complete Section A of the form, and then forward the partially completed form to your current (or most recent) landlord so they can complete Section B.

Once they have returned the now fully completed form, you must upload it to your application in the documents section.

If you do not have access to the internet, you can also return this document to the above address.

If you are currently renting your property, the reference must be filled in by the landlord from that tenancy, you cannot choose from a previous landlord.

If you are not currently renting, it must be completed by the most recent landlord you have had.

Section B must be completed by the landlord themselves (or company acting on their behalf), it cannot be completed by yourself or another person.

To log in to your application, click the following link https://southderbyshire.housingjigsaw.co.uk/ and sign in with your email address and password.

Kind regards,

Housing Solutions

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South Derbyshire District Council

Jigsaw Landlord Reference

Section A – To be completed by the applicant

Name:
Jigsaw Application Reference Number:
Current Address:	Postcode:
Contact Number:
Email Address:

I hereby consent to the Council’s Housing Department receiving conﬁdential information which may be required to determine my housing situation.

I consent to the housing department accessing my Housing Benefit and Council Tax records.

Furthermore, I agree that information about my housing situation can be shared with relevant agencies/profession and housing providers if it is relevant and necessary in resolving my housing difﬁculties.

Depending on the type enquires required for my case: Relevant agencies may include amongst others the following: Doctors, Hospital, Community and Mental Health Service, Citizen’s Advice Bureau, Probation Services, Prison Service, Educational Providers, Department of Work’s and Pension, Social Services, Past and Present Landlords, Past and Present Employers, Solicitors, Drug and Alcohol support Agency’s, Floating support and resettlement Services, Experian Credit Services.

Information will only be shared if it is relevant and necessary.

Even if someone else has ﬁlled in this form for you, you must sign this declaration if you can.

Please read the declaration carefully before you sign and date it I hereby declare that the information given on this form is correct and complete to the best of my knowledge.

I understand that under Section 214 of the Housing Act 1996 it is an offence to knowingly or recklessly make a statement which is false and/or withhold information in order to obtain assistance with accommodation.

It is also an offence if you do not notify the Council of any material change in your circumstances as soon as possible.

I am aware that if I give information that is incorrect or incomplete, the Council may take action against me. This may include court action and anyone guilty of such an offence is liable, on conviction, to a ﬁne of up to £5,000.

I authorise you to release the information requested about me below.

Signed………………………………………………………….	Date………………….

Section B – To be completed by the Landlord

Dear Landlord,

The above named person has applied for accommodation through South Derbyshire Jigsaw Choice Based Letting Scheme and is asking you to provide a Landlord Reference with respect to their current or former tenancy with you.

Would you please be so kind as to complete the information below and return it to the address stated at the bottom of this form?

Landlord Name:
Landlord Address:	Postcode:
Landlord Contact Number:
Landlord Email Address:

Property Address:	Postcode:
How many bedrooms does this property have?	How many Living Rooms/ Dining Rooms?
Names on the Tenancy Agreement:
Tenancy Type:
Tenancy Start Date	Tenancy End Date (if applicable)
Weekly Rent Payable:	£
Are there any current arrears?	(If yes, please statement the amount at the time of writing)
Has the Rent Account ever fallen into arrears?	(If yes, what action was taken?)
Is there a payment plan in place?	(If yes, what is the agreement?)
If a Deposit was paid, have you registered it with a Tenancy Deposit Scheme, and if so, which one?
Have you ever commenced legal action against the tenant at any time during the tenancy for Anti-Social Behaviour, rent arrears or any other breach of Tenancy?
Are you aware of any unspent convictions that the tenant may have been convicted of?
Please advise whether there has been any anti-social behaviour perpetrated by the tenant of the property/household member, giving details if applicable.
Has the applicant, tenant, members of their family or visitors ever caused nuisance or significant damage to the property?
Are you aware of any support needs in relation to the tenant or any members of their family? Do these support needs require them to have help in sustaining a tenancy?
Is there any risks or lone working factors that we need to consider with tenant, household members, family members or visitors?
Overall, has the Tenancy been conducted in a satisfactory manner, and do you think the applicant(s) will make good tenants? Please give details:

I hereby declare that the information given on this form is correct and complete to the best of my knowledge.

I understand that under Section 171 of the Housing Act 1996 it is an offence to knowingly or recklessly make a statement which is false and/or withhold information which the Council has reasonably required in connection with carrying out its housing allocation functions.

Landlord Signature…………………………………………………….	Date………………….

Thank you for your assistance, please return this form to the applicant or to housing.jigsaw@southderbyshire.gov.uk