Complaint Form

Complainant's Details
Tenure * REQUIRED
Title * REQUIRED
Forename(s) * REQUIRED
Surname * REQUIRED
Address * REQUIRED
Address Line 1 Address Line 2 Address Line 3 Address Line 4 Post Code
Phone * REQUIRED
Mobile * REQUIRED
Email * REQUIRED
Preferred contact method * REQUIRED
Who is making this complaint? * REQUIRED
- I am the complainant
- I am a representative
Accessibility and practical needs?
Other special requirements

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Representative's Details
Relationship with complainant * REQUIRED
Title * REQUIRED
Forename(s) * REQUIRED
Surname * REQUIRED
Job Title * REQUIRED
Organisation * REQUIRED
Address * REQUIRED
Address Line 1 Address Line 2 Address Line 3 Address Line 4 Post code
Telephone number * REQUIRED
Mobile number * REQUIRED
Fax number * REQUIRED
Email * REQUIRED
Website * REQUIRED
Reason for representation * REQUIRED
Is the Representative/Joint Complainant to be the primary point of contact? * REQUIRED
- Yes
- No
Is this a group complaint? * REQUIRED
- Yes
- No

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Complaint Details
Who is your Landlord? * REQUIRED
My complaint is about * REQUIRED
When did you first report this issue? - must be mm/dd/yyyy format * REQUIRED
MM slash DD slash YYYY
When did you make a formal complaint? - must be mm/dd/yyyy format * REQUIRED
MM slash DD slash YYYY
How have you been affected? * REQUIRED
What has the landlord done since you first submitted your complaint? * REQUIRED
What do you think the landlord should do to put the matter right? * REQUIRED
* Please note that you will no longer be able to 'Save til later' upon proceeding past this page.

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Supporting Evidence
*Please include the final response from your landlord
Attach Files:
Drop files here or

Max. file size: 8 MB, Max. files: 10.
Maximum file size - 8 mega bytes.

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Monitoring information

Please note that there is a 'prefer not to say' option on each question below if you don't wish to provide the following information.
Ethnicity: How would you describe your ethnic origin? * REQUIRED
Gender: What is your sex? * REQUIRED
Sexuality: Do you identify as: * REQUIRED
Marital status: Are you married or in a civil partnership? * REQUIRED
Religion: Please indicate your religion, practice or belief: * REQUIRED
Age: Please indicate your age: * REQUIRED
Disability: Do you consider yourself to have a disability? * REQUIRED
Disability Notes * REQUIRED
If you have none, please fill in not applicable.

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Review Submission