Application Form for a House in Multiple Occupation (HMO) Licence

Application Form for a House in Multiple Occupation (HMO) Licence
NOTE TO APPLICANTS

Please note that it is a criminal offence to knowingly supply information which is false or misleading for the purposes of obtaining a licence. Evidence of any statements made in this application with regard to the property concerned may be required at a later date. If we subsequently discover something which is relevant and which you should have disclosed, or which has been incorrectly stated or described, your licence may be cancelled or other action taken.

Please also note in undertaking checks to establish that you are a fit and proper person we will be contacting other departments within the council - e.g. Council Tax and Benefits and we may also approach other authorities such as the Police, Fire and Rescue Service, Office of Fair Trading etc, for information and confirmation.
PART 1 - LANDLORD INFORMATION

This section must be completed by the applicant
Address of the HMO

House name/number

Street

TownState / Province

Postal Code
Applicant Name

TitleFirst NameLast Name
Applicant's Address

House name/number

Street

TownState / Province

Postal Code
Applicant's Email Address
example@example.com
Applicant's Phone Number
Please enter a valid phone number.
Professional Qualifications - e.g. RICS, NALS, ARMA, ARLA

Part 2 - Agent / Manager / Rent Collector

Please ONLY complete this if the details are different from the landlord
Do you employ an Agent, Manager or Rent Collector?

YesNo
Name of Agent / Manager / Rent Collector employed by the applicant (if applicable)

TitleFirst NameLast Name
Address of Agent / Manager / Rent Collector

House name/number

Street

TownState / Province

Postal Code
Phone Number of Agent / Manager / Rent Collector
Please enter a valid phone number.
Email address of Agent / Manager / Rent Collector
example@example.com
Professional Qualifications e.g. RICS, NALS, ARMA, ARLA
Is the Agent / Manager / Rent Collector part of a company?

YesNo
Please provide details of the company/partnership/trust including the registered office address or principal trading address where appropriate and professional qualifications

House / Building Name or Number

Street / Road

TownState / Province

Post Code
Contact Number
Please enter a valid phone number.
Email address
example@example.com
Professional Qualifications
Name of Company Secretary

PrefixFirst NameLast Name
Address of Company Secretary

House Name / Number

Street / Road

TownState / Province

Post Code
Contact Number
Please enter a valid phone number.
Email address
example@example.com

Fit & proper person
The local authority must have regard (amongst other things) to evidence which shows that a person or any person associated or formerly associated whether personally or on a work basis with the property provided it is relevant to whether the person is fit and proper, has

Been convicted of an offence involving:

Fraud

Dishonesty

Violence

Drugs

Sexual Offences Act Schedule 3

Practised unlawful discrimination on grounds of sex, colour, race, ethnic or national origins or disability in connection with a business.

Contravened any provision of housing or landlord and tenant law. In particular, within the last five years been in control of any property:

subject to a control order

subject to proceedings by a local authority

where the local authority has had to carry out works in default

subject to a management order under the Housing Act 2004

Or been refused a licence or breached conditions of a licence

Acted in contravention of any Approved Code of Practice (ACoP).

Please note we may require your co-operation in obtaining Criminal Records Bureau (CRB) or similar information in confirmation of the above.
Do any of the above apply to you or anyone else involved in the management of the property?

YesNo
If Yes, please provide details
Are you a member of any landlord's association or other professional body?

YesNo
If Yes, which one?
Are you a member of an accreditation scheme in this or another local authority?

YesNo
If Yes, please provide details
Are you a licensed manager in this or another local authority?

YesNo
If Yes, please provide details
Please list any training courses you have undertaken or conferences attended in the last three years which you feel may make you a more informed manager
Which Government Letting Agent Redress Scheme are you registered with?
Please note that it is a criminal offence to knowingly supply information which is false or misleading for the purposes of obtaining a licence. Evidence of any statements made in this application with regard to the property concerned may be required at a later date. If we subsequently discover something which is relevant and which you should have disclosed, or which has been incorrectly stated or described, your licence may be cancelled or other action taken. Please note in undertaking checks to establish that you are a fir and proper person we will be contacting other sections within the Council e.g. Benefits and Council Tax departments and we may also approach other authorities such as the Police, Fire and Rescue Service, Office of Fair Trading etc for information and confirmation. By ticking the declaration at the end of this form will constitute your consent to this.

Part 3 - Owners of a Licensable Property Certificate of Title
Property Address

House Name / Number

Street / Road

TownState / Province

Post Code
I / We having consulted the Deeds of this property confirm for the purpose indicated above the full name(s) and address(es) of all the owners (please list below). The Title to the property is freehold/leasehold (i.e. a term of years of which is not less than five years remain unexpired at the date of application)
Date

DayMonthYear

Part 6(a) - Complete for Bedsit Houses

Please indicate number of rooms / facilities on each floor

	Floor	Rooms	Occupants (inc children)	Cooking facilities	Food storage	Bath/Shower	WC	Wash hand basin	Smoke/heat detectors
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Please indicate the number of occupiers for which you would like a licence
This incudes adults and children
Please upload your documentation here. You can refer to the checklist link below to make sure you have all the necessary documentation to upload.

Cancelof
Please click here for the checklist of information required
Declaration
I/We declare that the house in respect of which a licence is sought under Part 2/Part 3 of the Housing Act 2004 is subject to a licence under that Part at the time this application is made. I/we understand that an offence may be committed 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 to be false or misleading or am/are reckless as to whether it is false or misleading. I/we declare that I/we have read this statement and completed all parts of this application to the best of my/our knowledge and ability, and that it is valid as of the date below. I/we agree to Surrey Heath Borough Council sharing information with other sections of the Council, and external bodies such as the council’s partners.

Please tick
Date

DayMonthYear
If there is any part of this application that has been omitted or completed incorrectly and/or there are documents missing, the application will be rejected. If you operate a mandatory licensable HMO without one during this intervening period, you may be committing an offence.
Upon submission of this application, you will be redirected to our online payment facility to make your payment. You will need to select the HMO Licence Fee payment category from the dropdown list and make your payment using either a debit or credit card. The current fee is £878.63. Your payment confirmation email will act as your receipt of payment.

If you are a member of any nationally recognised Landlord Accreditation Scheme or Association, this fee is reduced to £758.53 but only in conjunction with the necessary documentation demonstrating a current membership. In addition to this you will be required to attach the information required to this application using the file upload option. Please note if any of the required information is missing we may be unable to process this application for a licence. If payment is not made on submission of this form your application will not be processed.

The HMO Licencing Team will receive your application and attached documents and process your application. If you have any queries relating to the application then you can contact a member of the Private Sector Housing Team on 01276 707100.

If your tenants are foreign nationals, to comply with an amendment to the Housing Act 2004 you MUST now supply copies of the relevant pages of each tenant's Passport(s).
Privacy Statement

Details of Surrey Heath Borough Council’s Privacy Notice can be found here
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Application Form for a House in Multiple Occupation (HMO) Licence

PART 1 - LANDLORD INFORMATION

Fit & proper person

Part 2 - Agent / Manager / Rent Collector

Fit & proper person

Part 3 - Owners of a Licensable Property Certificate of Title

Part 4 - Property Information

Fire Precautions

Heating / Hot water and Insulation

Gas safety

Electrical Safety

Electrical appliances and furniture

Part 5 - Tenancy Management

Part 6(a) - Complete for Bedsit Houses

Declaration