Tenant Assessment

Application Form

Part A should be completed by Chelton Brown Ltd. The other sections shouldbe completed by the tenant applicant or
guarantor, according to the type of assessment required.

Once completed in full, the application should be returned to Chelton Brown Ltd.

Part A - To be completed by Chelton Brown Ltd

Agent Name: Chelton Brown Ltd
Contact Name: Anita / Anna
Contact Telephone Number: 01604 603433

Property Details

Landlord Name(s)
House Name / Number Street
District Town
County Postcode
Total Rent    
Tenancy Commencement Period

Part B - To be completed by the applicant

Mandatory for all assessments. If more than one applicant, parts C to G inclusive must be completed as appropriate for each.

How many adult tenants will there be?
  First Name Middle Name(s) Surname Share of Rent
Tenant 1
Tenant 2
Tenant 3
Tenant 4

Part C - To be completed by the applicant

Mandatory for all assessments. If more than one applicant, parts C to G inclusive must be completed as appropriate for each.

Personal Details

Title First Name Middle Name(s) Surname
Date of Birth (dd/mm/yyyy) Sex Male Female
Marital Status Maiden Name
Phone (daytime) Phone (evening)
Mobile Email
Do you have any pets? Yes No Are you a smoker? Yes No
No. of Children
Are you aware of any CCJ/CD or Bankruptcy? Yes No (if yes, give details below)
Number of cars Make
Model Reg. No

Current Address

House Number / Name Street
District Town
County Postcode
Status Owner Rented Living with parents Council tenant Other
Time at address years months

Previous Address

House Number / Name Street
District Town
County Postcode
Status Owner Rented Living with parents Council tenant Other
Time at address years months

Part D - To be completed by the applicant for
comprehensive assessments

Employment Details

If you indicate retired or housewife and you are currently, or have previously, lived in rented accommodation, proceed to
Part D Landlords details, otherwise proceed to Part E.

Employment Status Employed Self-Employed Retired Housewife
Employer
Job title
Street Number Street
Town Postcode
Contact Name Contact job title
Phone (daytime) Fax
Email    
Annual Salary (gross) Employment start date
National Insurance no.    
       
If you have additional income, please advise how much per annum
If your job is likely to change, or you have additional income, please give details

Landlord Details

Complete this section if you indicated that you are, or have lived, in rented accommodation.

Landlord / Agent Name
House Number / Name Street
District Town
County Postcode
Phone (daytime) Phone (mobile)
Fax Email

Next of Kin

This must be a person not living with you.

Name
House Number / Name Street
District Town
County Postcode
Phone (daytime) Phone (mobile)
Fax Email

Part E - To be completed by the applicant (mandatory)

Bank / Building Society details

Please give branch address details, including postcode.

Sort Code Account Number
Bank Name
Branch Address
Account in the name of How long with this branch?
Do you have a cheque guarantee card? Yes No

Applicant's Consent

In connection with this application, a search will be carried out to check all or any of the application details which
have been submitted. I consent to this information being shared with other organisations for the purposes of
assessing tenant applications and services.

By signing this form I also expressly consent to passing the results of any such search or assessment to my prospective
landlord(s) for the purpose of assessing this application.