Please Use Black Or Blue Ink to Complete This Form for Each Licence Application

Newcastle City Council

HMO Mandatory Licensing Application Form

Please read the entire form and the Standards and Guidance Notes carefully before completing this form.

Prior to submitting your application, please use this checklist to ensure you have enclosed all the required documents and the correct fee. Failure to do so will mean your application cannot be validated and will not be processed. a. Evidence of permanent residential address of proposed licence holder b. Building Regulations completion certificate – if applicable c. Fire alarm test certificate d. Emergency lighting system test certificate e. Service contract for alarm and fire systems f. Landlord’s Gas Safety Certificate (CP 12) g. Periodic test certificate for the electrical installation (5 yearly) h. PAT declaration (electrical appliance test)

Licence fee enclosed i. £ 843.00 For a first licence application by a proposed licence holder £ 575.00 For a subsequent licence application by an existing licence holder Management Statement (including anti-social behaviour policy and fire j. safety instructions)

PART 1: GENERAL PARTICULARS

Address of HMO to be licensed: Name and address of the owner of the property to be licensed Title: Mr Mrs Miss Ms Other

Last name: First name: Address:

Name and address of the managing agent of the property to be licensed, if applicable Title: Mr Mrs Miss Ms Other

Last name: First name: Company name: Address:

Postcode:

Please indicate who the proposed licence holder will be. If ‘other’, please state name, address and interest in property overleaf. Property owner: Managing agent: Other:

Name and address of the proposed licence holder, if not the owner or managing agent. Title: Mr Mrs Miss Ms Other

Last name: First name: Address:

Interest in property:

If the proposed licence holder is not the owner or managing agent of the property, the owner and proposed licence holder must sign the following declaration …

I, as the owner of the above property, hereby give my consent to the above named person being the licence holder. Name – please print: Date: Signature:

I consent to being named as the proposed licence holder of the above property. Name – please print: Date:

2 Signature:

Please indicate the type of licence which you are applying for … Application for a Licence Application for a variation of an existing Licence Renewal of a Licence Please indicate the type of property for which the application is being made … House in multiple occupation Flat in multiple occupation Property converted into units of accommodation which are not self- contained flats [although there may also be self-contained flat(s)] Please indicate how the HMO is operating … Shared facilities Bedsits with some shared facilities A dwelling-house with lodgers A hostel Supported lodgings

PART 2: DETAILS OF PROPOSED LICENCE HOLDER 2.1 Name and address of proposed licence holder: The address provided for an individual should be their permanent residence address and adequate proof must be provided. Examples would include: driving licence; recent bank or building society statement or recent tax correspondence; recent utility bill. Title: Mr Mrs Miss Ms Other

Last name: First name: Residential address:

Postcode: Home telephone no: Work telephone no: Mobile telephone no: e-mail address: Proof of address enclosed: Interest in property: 2.2 If the proposed licence holder is a company, partnership, charity or trust, please indicate which and complete the following. If not, please go to 2.6.1 Company Partnership Charity Trust:

Company/partnership/charity/trust address including registered office:

Postcode: Telephone no: e-mail address:

2.3 Please provide contact details for all directors / partners / trustees – please use a separate sheet if more than two. Pre-printed information about the organisation is acceptable, validated by the signature of the appropriate officer. Director Partner Trustee Director Partner Trustee

Title: Mr Mrs Miss Ms Other Title: Mr Mrs Miss Ms Other Last name: Last name: First name: First name: Address: Address:

Postcode: Postcode: Telephone no: Telephone no: e-mail address: e-mail address:

2.4 Please provide details of the Company Secretary: Title: Mr Mrs Miss Ms Other

Company Secretary address:

Postcode: Telephone no: e-mail address:

4 2.5 Please provide an address where all official correspondence should be sent. All partners / trustees should sign their agreement to this address. This will be the address used on the public register. Name of person/company: Correspondence address:

Postcode: Telephone no: e-mail address: 2.6.1 Fit and Proper Person –Please refer to Part 6 and the standards and guidance document before completing this section

The Local Authority “must have regard (among other things) to” evidence which shows that the proposed licence holder (PLH) or any person associated or formerly associated, whether personally or on a work basis with that person, provided it is relevant to whether the proposed licence holder is fit and proper, has

Committed an offence involving Fraud Dishonesty Violence Drugs Sexual Offences Act 2003, Schedule 3 (offences attracting notification requirements)

The proposed licence holder is required to provide a declaration to confirm or otherwise their status with regard to criminal offences. To satisfy this requirement a disclosure statement must be obtained from Disclosure Scotland (see guidance document for contact details). This will detail any unspent convictions under the Rehabilitation of Offenders Act 1974.

Declaration Enclosed………………………………………… Yes No

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

c) Contravened any provision of Housing, Public Health, Environmental Protection or Building Act legislation and has been served with a Notice and in particular within the last 5 years been in control of any property  Subject to a Control Order under s379 of the Housing Act 1985  Subject to civil or criminal proceedings in respect of the above legislation resulting in a judgement being made.  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.

d) Been cautioned or convicted of an offence under landlord and tenant law such as illegal eviction or harassment.

e) Acted in contravention of any Approved Code of Practice (ACoP) approved under S235 of the Housing Act 2004.

f) Been refused a licence under Parts 2 or 3 of the Housing Act 2004.

We may approach other Authorities such as the Police Authority, Fire and Rescue Service, Office of Fair Trading and the County Court etc, for information and confirmation. Signing of the application will be taken as your agreement to any such action.

6 2.6.2 Do any of the above (a-f) apply to you or anyone involved in the management of the property? If so, please enter details, continue on a separate sheet of paper if necessary Name of relevant Details of offence / Date Court / Police Local Authority person & caution, notice or work Heard Force relationship to in default etc. and PLH. property details

I, as the manager hereby authorise any statutory body holding information about me, which falls within the categories above, to provide this information on request by the Council. Name – please print: Date: Signature:

2.6.3 Has the proposed licence holder applied to be a licence holder in respect of any other properties situated in Newcastle upon Tyne or any other local authority area? Please provide details below, and use extra sheets of paper if necessary. Address of property Name and address of local Date of issue of licence council issuing licence

2.6.4 Is the proposed licence holder an accredited landlord in this or another authority? Please indicate which local authority.

2.6.5 Number of other properties owned by the proposed licence holder within this authority.

2.6.6 Number of other properties owned by the proposed licence holder in another authority. Please indicate which local authority.

2.6.7 Is the proposed licence holder a member of any landlords association or other professional body? Please indicate which.

2.6.8 Please list training courses / conferences attended – relevant to property management – by the proposed licence holder in the last three years. 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.

8 PART 3: TO BE COMPLETED IF MANAGER EMPLOYED 3.1 This form must be completed by the person who will be responsible for the management of the property. Property Address:

Post Code:

3.2 Name and Address of person managing the property indicating professional qualifications such as RICS, ARMA, ARLA etc. and position within the organisation. Title: Mr Mrs Miss Ms Other

Last name: First name: Residential address:

Postcode: Home telephone no: Work telephone no: Mobile telephone no: e-mail address: Proof of address:

3.3 If the manager is a company, partnership, charity or trust, please indicate which and complete the following. Company Partnership Charity Trust:

Company/partnership/charity/trus t address including registered office:

Postcode: Telephone no: e-mail address: 3.4 Names and addresses of all Directors / Partners / Trustees indicating professional qualifications such as RICS, ARMA, ARLA etc. (please use separate sheet if necessary) Pre printed information about your organisation is acceptable, validated by the signature of the appropriate person. Name: Address:

Telephone Number: Email Address: Qualifications:

Name: Address:

Telephone Number: Email Address: Qualifications:

3.5 Name and Address of Company Secretary Name: Address:

Telephone Number: Email Address:

3.6 In the case of a partnership or trust please provide details of the person nominated to receive correspondence on behalf of the partnership or trust and the address for service in respect of the Licence / Notices etc, if different from above. Nominated Person: Address

Post Code:

10 3.7 Please provide name and address of the person in control of the house (i.e. the person to whom all the rent is paid directly). Name: Address:

Postcode: Telephone: Email Address: 3.8.1 Fit and Proper Person The Local Authority “must have regard (among other things) to” evidence, which shows whether the manager or any person associated or formerly associated, whether personally or on a work basis with the property, provided it is relevant to whether that person is fit and proper, has Committed an offence involving  Fraud  Dishonesty  Violence  Drugs  Sexual Offences Act Schedule 3 You are required to provide a declaration to confirm or otherwise your status with regard to criminal offences. To satisfy this requirement you must obtain disclosure details from Disclosure Scotland (see guidance document for contact details). A current CRB report (valid within 6 months of issue) will also be acceptable. This will detail any unspent convictions under the Rehabilitation of Offenders Act 1974.

Declaration Enclosed ……………………………………………….. Yes / No

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

c) Contravened any position of Housing, Public Health, Environmental Protection Act or Building Act Legislation and has been served with a notice. In particular within the last 5 years been in control of any property  Subject to a Control Order under s379 of the Housing Act 1985  Subject to civil or criminal proceedings in respect of the above legislation resulting in a judgement being made.  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.

d) Been cautioned or convicted of an offence under landlord and tenant law such as illegal evictions or harassment.

e) Acted in contravention of any Approved Code of Practice (ACoP) approved under S235 of the Housing Act 2004

f) Been refused a licence under Parts 2 or 3 of the Housing Act 2004.

We may approach other Authorities such as the Police Authority, Fire and Rescue Service, Office of Fair Trading and the County Court etc, for information and confirmation. Signing of the application will be taken as your agreement to any such action.

12 3.8.2 Do any of the above (a-f) apply to you or anyone involved in the management of the property? If so, please enter details, continue on a separate sheet of paper if necessary Name of relevant Details of offence / Date Court / Police Local Authority person & caution, notice or work Heard Force relationship to in default etc. and PLH. property details

I, as the proposed manager, hereby authorise any statutory body holding information about me, which falls within the categories above, to provide this information on request by the Council. Name – please print: Date: Signature:

Has the proposed licence holder applied to be a licence holder in respect of any other properties 3.8.3 situated in Newcastle upon Tyne or any other local authority area? Please provide details below, and use extra sheets of paper if necessary. Address of property Name and address of local Date of issue of licence council issuing licence

3.8.4 Is the proposed licence holder an accredited landlord in this or another authority? Please indicate which local authority.

3.8.5 Number of non-licensable properties managed by the proposed licence holder within this authority.

3.8.6 Number of non-licensable properties managed by the proposed licence holder in any other authority. Please indicate which local authority. 3.8.7 Are you a member of any landlords association or other professional body? Please indicate which

3.8.8 Please list any training courses you have undertaken or conferences attended in the last 3 years which you feel contributes to the good management of the property Course / Conference Name Date

3.9 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.

14 Part 4 Notification to relevant persons

4.1 You must let certain persons know in writing that you have made this application, or give them a copy of it. You can do this by completing the attached form.

The persons who need to know about it are:-  Any mortgagee  Any owner of the property to which the application relates (if that is not yourself) 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 a flat) who is known to you, other than a statutory tenant or other tenant whose lease or tenancy is for less than 3 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 condition(s) in a licence if it is granted.

You must tell each of these persons:-  Your name, address, telephone number and email address (if any).  The name, address, telephone number and email address (if any) of the proposed licence holder (if it will not be you).  The address of the property to be licensed.  The application refers to a part 2 (HMO) Licence.  The name and address of the Local Authority to which the application will be made.  The date the licence will be submitted.

I/We confirm that I/we have served notice of this application on the following people, who are the only people known to me/us that are required to be informed that I/we have made this application. Name – please Date: print: Signature: Name – please Date: print: Signature:

4.2 Name: Address:

Postcode: Interest in the property or the application: Date of service of Notice:

Name: Address:

N.B. If you are applying for a licence for more than one property and the same information applies to all of those properties, you need only complete this form once.

You may use the following form to make the appropriate notifications to persons having an interest in the property.

16 Notification to persons having an interest in the property to be licensed

Details of Applicant Name: Address:

Postcode: Tel Number: Email Address: Details of proposed licence holder ( if he is not the applicant ) Name: Address:

Postcode: Tel Number: Email Address: Address of property to which it relates:

Postcode: Name and address of Local Authority to which application is being made:

Date Application to be submitted PART 5: DETAILS OF PROPERTY TO BE LICENSED – to be completed for all properties 5.2.1 Details of property Property Address:

Postcode: Please indicate the type of property to be licensed. Type: Detached Semi-detached Terrace End-terrace

Please give approximate date of construction of the property. Date: Pre 1919 1919 –1945 1945 – 1964 1965 – 1980

If converted, approximate date of conversion: Date: Please provide details of any building works carried out to the property since 1985. Please include copies of planning consents, building regulations approval or certificates issued on completion of works. Before carrying out any work to comply with the requirements contained within these standards you should consult the Building Control Section and Development Control team. In addition if the building is Listed or is located in a Conservation Area you will need permission from the Conservation and Historic Environment team before carrying out any work. Note: In certain parts of the city planning permission is required for the change of use of a house to a house in multiple occupation. For further information contact Development Management on 01912115639 or email [email protected] Description of Date of completion works

5.2.3 How many storeys are there in the property? (include basements and attics)

Storeys: 1 2 3 4 5 other

5.2.4 Is any part of the property used for commercial activity including accommodation not in your ownership? If yes state location and use: Yes No

5.25 How many separate letting units are there in the house? Letting units: 1 2 3 4 5 6 7 8 other

18 5.3.1 Details of Occupation Proposed maximum number of occupants/households to which application refers.

5.3.2 Number of tenants/residents who occupy the property at present

5.3.3 Number of separate households who occupy the property

5.3.4 Is any accommodation used by the owner(s), family or family of person(s) managing the premises entirely separate from accommodation used by tenants? If Yes indicate number of persons.

5.4.1 Number of Rooms 5.4.2 Total number of letting bedrooms

5.4.3 Total number of common rooms available for use by residents i.e. lounge / dining room etc

5.4.4 Total number of rooms used for private accommodation by owner / manager

5.5.1 Board Arrangements Do you provide meals Yes No

State which

5.6.1 Space standards 5.6.2 Do all the bedrooms / bed-sitting rooms meet the standards with regard to floor area? Yes No

If No how is it deficient:

5.7.1 Kitchen Facilities 5.7.2 Space – Does the kitchen meet the standards with regard to space? Yes No

If No how is it deficient:

5.7.3 Is the kitchen provided with ventilation? Yes No

5.7.4 Indicate by which means Openable Window Extract Ventilation Other (state) 5.8.1 Number of Facilities 5.8.2 Please complete the following table indicating the number of facilities, and whether they are shared or for sole use. Children of any age, including babies, must be included in the number of people. Number of facilities Number of people sharing facility Rooms providing living accommodation Rooms providing sleeping accommodation Kitchen Cooker Sink with drainer Fridge Freezer

Fridge/Freezer Microwave oven Dishwasher Fixed work surface for food preparation – please indicate in linear metres Electrical sockets in kitchen area above work tops Electrical sockets in kitchen area below work tops Fire blanket and multi-purpose extinguisher provided Refuse storage bin 5.8.3 Is there a supply of cold water and constant hot water to the sink(s) Provide details of how the water is heated. Yes No

5.9.1 Provision of personal washing facilities and sanitary accommodation 5.9.2 Please complete the following table indicating the number of facilities, and whether they are shared or for sole use. Children of any age, including babies, must be included in the number of people. Number of Number of people Ensuite  rooms sharing facility Bathroom with toilet and wash hand basin Shower room with toilet and wash hand basin Bathroom with wash hand basin Shower room with wash hand basin Room containing bath only Room containing shower only Separate toilet with wash hand basin Separate toilet without wash hand basin

20 Wash hand basin in bedsit/ B&B accommodation

5.9.3 Is there a supply of cold water and constant hot water to the washing facilities. Provide details of how the water is heated. Yes No

If No how is it deficient

5.9.4 Is the bathroom provided with ventilation? Yes No

Indicate by which means Openable Window Extract Vent Other (state which) 5.9.5 Is the bath/shower room provided with heating? Yes No

Please state how it is provided

5.10.1 Heating 5.10.2 Are all habitable rooms provided with permanently fixed heating facilities Yes No

5.10.3 What form of heating does the property have? Gas fired central heating Off peak night storage heaters Individual fixed flued gas heaters Individual fixed electrical heaters Other

5.11.1 Security 5.11.2 Does the property comply with the security standards? If you answer no we will not be able to complete the application process until we receive confirmation of full compliance. Yes No

5.11.3 If the property has an intruder alarm have you provided key holder details to the Council’s Environment Team, if No please enter the details below Yes No

Name: Address:

Post Code: Contact Telephone Number:

5.12.1 Fire Precautions Please refer to the guide before completing this section Please note that for a licence to be issued the property must comply with the standard laid down in Part 9 of the Standards document. 5.12.2 Does the property meet the full fire precautions standard laid down in the guidance document? Yes No

5.12.3 Is your property provided with a hard wired interconnected alarm and detection system in the common parts? Yes No

5.12.4 Is your property provided with a hard wired interconnected alarm and detection system in the common parts and all other locations indicated in the Standard? Yes No

5.12.5 Is your system fitted with a fire alarm panel? Yes No

5.12.6 Is there emergency lighting in the common ways? Yes No

5.12.7 Is the escape route protected by fire doors as described in the standard? Yes No

5.12.8 Is the escape route kept clear of flammable material and other obstructions? Yes No

5.12.9 Are all ceilings and those walls indicated with a red line in the standard in sound condition? Yes No

5.12.10 Do you have a contractor to maintain and inspect your system? Yes No

If Yes please state who 5.12.11 Is there a log book of inspection / testing? Yes No

If Yes where is it kept? 5.12.12 Is there a current fire alarm test certificate? Yes No

If Yes please enclose a copy. If No you must make arrangements to have the system tested.

22 5.12.13 Have you provided fire safety instructions for residents and any employees regarding actions to be taken in the event of a fire and the escape routes to be used. Yes No

5.13.1 Property Management Is the property: Yes No 5.13.2 Structurally sound and in good repair

5.13.3 Maintained in a clean condition, in internal good repair and provided with suitable curtains or blinds at all windows

5.13.4 Maintained in good external decorative repair

5.13.5 Kept free from accumulations of refuse/litter and have arrangements been made to ensure that gardens and paved areas are kept in good order and tidy condition 5.13.6 Secure; with adequate door and window locks (see guidance note for standards) 5.13.7 Provided with adequate facilities for the storage and disposal of refuse 5.13.8 Provided with furniture as part of the letting arrangements If yes, please sign the following declaration to indicate that the Furniture and Furnishings (Fire) (Safety) Regulations 1998 are complied with and that there are arrangements for the routine inspection of all items provided by the landlord to ensure that they are maintained in good / safe condition. Please provide details of the maintenance regime under Arrangements for Managing the Property.

I declare that all the relevant furniture and furnishings supplied for use at the property comply with the above regulations.

Signed______

Yes No 5.13.9 Does the property have a gas supply

If YES have you enclosed a Certificate of Gas Safety (CP 12)

5.13.10 Has the hard wired electrical system been inspected within the last 5 years 5.13.11 Have you a schedule for the testing of all electrical appliances over 12 months old 5.13.12 Have you a schedule for the routine examination of all landlord provided equipment/fittings. If yes please detail and attach to enclosures. 5.14.1 Financial status A licence holder must have the financial arrangements necessary to make sure that the property is properly managed and maintained. 5.14.2 Is the proposed licence holder or anyone associated with the licence holder an un-discharged bankrupt? If yes, please provide details:

5.14.3 Are there any outstanding County Court judgements against the proposed licence holder or anyone associated with the licence holder or any company of which they are director or secretary? If yes, please provide details.

5.14.4 If the proposed licence holder/manager does not hold a freehold interest or long lease with full repairing obligations please answer the following questions … 5.14.5 Do they have power to carry out any works required by the local authority? 5.14.6 Is there any financial limitation on the amount of work they can carry out? 5.14.7 Please detail below the value of work that can be carried out without further authorisation, and the procedure that must be followed if works exceed this limit.

5.15.1 Tenancy Management Please confirm whether you provide the following Yes No Tenancy agreements/written details of terms of tenancy, including sanctions for anti social behaviour. Please provide copies, if you use a standard form of agreement please provide a copy of this. Inventory and schedule of condition at commencement of letting

Rent book/receipts Written instructions for tenants to report disrepair/tenancy issues Complaints procedure 24 5.16 Please attach a sketch plan, with measurements, showing the location and size of each room in the property. Below is an example showing the type of sketch and detail required. Please use the abbreviations listed below to mark details on the plan. Please provide a separate sketch of each floor level of the property. Please add additional sheets if you require further space. If you already have plans of the property you may submit these separately, or we can provide plans for you at a charge. 26 Sketch Plan

Notes PART 6: INFORMATION ON DISCLOSURE AND SPENT OFFENCES Under the Housing Act 2004, licence holders and managers of houses in multiple occupation must be fit and proper persons to undertake the responsibilities of running them. In order to assist the Council in making proper assessments of suitability, details about previous convictions for criminal offences must be disclosed. Under the Rehabilitation of Offenders Act 1974, there is no requirement to provide details about previous convictions that are ‘spent’. A conviction becomes spent after a certain length of time, which changes depending upon the sentence and the age of the person at the time of conviction. The periods are halved if the conviction took place when aged 17 or less.

Sentence Period of good conduct needed for conviction to be spent 6 months to 2½ years imprisonment 10 years Less than 6 months' imprisonment 7 years Borstal Training 7 years A fine or Community Services Order 5 years Probation Order, Conditional Discharge, or 1 year Bind Over An Absolute Discharge 6 months

N.B. If you are convicted of any relevant offence(s) within the licence period you must notify the Authority immediately.

PART 7: DECLARATIONS OF APPLICANT AND PROPOSED LICENCE HOLDER Please note that it is a criminal offence to knowingly supply information that is false or misleading for the purposes of obtaining a licence. Evidence of any statements made in this application may be required at a later date. If we subsequently discover something, that 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. Operating an HMO that should be licensed without a licence is an offence liable to a fine not exceeding £20,000. In addition, a Residential Property Tribunal may make a rent repayment order requiring you to repay any rents due during the period for which the property was unlicensed.

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 functions under Parts 1 to 4 of the Housing Act 2004 that is false or misleading and which I/we know is false or misleading or I/we are reckless as to whether it is false or misleading. I/we declare that I/we have read the statement above and completed all parts of this application to the best of my/our knowledge and ability, and it is valid as of the date below.

Name – please print: Date: Signature: Name – please print: Date: Signature: Name – please print: Date: Signature: Name – please print: Date: Signature:

(In the case of partnerships or trustees, all partners or trustees must sign. In the case of a limited company, the form must be signed by a Director or Company Secretary or other authorised officer, in which case we will require proof of authority)

Financial Status A licence holder must have appropriate finance available to ensure the proper management and maintenance of the property. Where a manager is employed financial arrangements must be made which would enable them to carry out works deemed necessary for the proper management of the property. Please confirm that adequate arrangements have been made to ensure that finance is available to achieve compliance with the conditions required by the licence and approved standards. Is the proposed licence holder or anyone associated with the licence holder or the direct management of the property an un-discharged bankrupt or are there any county court judgements outstanding against these persons. YES NO If Yes, please provide details:

Please sign the following declaration confirming that adequate financial arrangements have been made to ensure compliance with all relevant statutory obligations. Owners Name please print Signature: Managers Name please print Signature:

If you require this information in large print, or in any other format please contact us on (0191) 2116103. NEWCASTLE CITY COUNCIL