To: Name and Address of person you must notify 5.1.1 This document is to Your Full Name 5.2.1 inform you that I of Your Address 5.2.2 My telephone number is Your Telephone Number 5.2.3 My e-mail address is Your e-mail Address 5.2.4 Intend on Intended Date of Application 5.2.5 To apply under Part 2 of Name of Local Authority 5.2.6 the Housing Act 2004 to for an HMO licence in Address of HMO to be licensed 5.2.7 respect of The licence holder will Licence Holder’s Name 5.2.8 be (if not you) of Licence Holder’s Address 5.2.9 The licence holder’s Licence Holder’s Tel. Number 5.2.10 telephone number is The licence holder’s e- Licence Holders e-mail 5.2.11 mail address is address Signed Licence Applicant(s) Date
To: Name and Address of person you must notify 5.1.1 5.2.1 This document is to inform you that I Your Full Name 5.2.2 of Your Address 5.2.3 My telephone number is Your Telephone Number 5.2.4 My e-mail address is Your e-mail Address 5.2.5 Intend on Intended Date of Application 5.2.6 To apply under Part 2 of the Housing Act 2004 to Name of Local Authority 5.2.7 for an HMO licence in respect of Address of HMO to be licensed 5.2.8 The licence holder will be (if not you) Licence Holder’s Name 5.2.9 of Licence Holder’s Address 5.2.10 The licence holder’s telephone number is Licence Holder’s Tel. Number 5.2.11 The licence holder’s e- mail address is Licence Holders e-mail address Signed Licence Applicant(s) Date
web175-hmo-licence-application-form.docx