Fillable APPLICATION FOR HMO LICENCE HOUSING ACT 2004 To (Bromsgrove District Council)

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APPLICATION FOR HMO LICENCE HOUSING ACT 2004 To (Bromsgrove District Council)

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HOUSING ACT 2004
Reference
number:
APPLICATION FOR
HMO LICENCE
Please fill in this form in
black
or
blue
ink only. Write clearly within the boxes provided and complete in
conjunction with the guidance notes. If you do not complete all of the relevant sections accurately and in
full, the processing of the application may be delayed and incur further charges.
ONLY COMPLETE THIS APPLICATION FORM FOR A HOUSE IN MULTIPLE OCCUPATION THAT REQUIRES
A LICENCE. THIS CAN BE ASSESSED BY READING THE GUIDANCE NOTES ACCOMPANYING THIS FORM
To
I/WE APPLY for [variation of] a HMO Licence.
Signed
Dated
Have you applied for a HMO licence
Address of HMO to be licensed:
within another authority?
Yes No
If you have ticked 'yes', please indicate below
which authority you have applied to or been
Postcode:
granted a licence by.
Date granted
application you are making
Please indicate which type of licence
Local Authority
Application for a new licence
Variation of an existing licence
Please indicate the type of house for
which the application is being made
(see note 1)
House in multiple occupation
Flat in multiple occupation
Have you applied for a HMO licence for
another HMO within the area of
Redditch Borough Council
A house converted and comprising
only of self-contained flats
Yes No
Please indicate how the HMO is
If you have ticked 'yes', please fill in the details
operating
(see note 2)
overleaf and go to part 2 unless any details in
HMO - bed-sits
previous applications have changed. If any
details have changed, please go to Part 1 and
HMO with shared facilities
complete all subsequent parts of the form.
Household with lodgers
If you have ticked 'no', please go to Part 1 and
A hostel, B&B or guesthouse
complete all the necessary parts of the form, in
full.
Supported lodgings
If the property does not require a licence,
Other, please specify:
please complete the declaration overleaf and
return to the above address
Postcode:
Title: Mr Mrs Miss Other
Full name:
Address:
Telephone:
Ms
The following details are required from
Details of the Person having control of
applicants who have already submitted an
the HMO
HMO licensing application form to enable the
Council to find the records.
Title: Mr Mrs Miss Ms Other
Details of the Applicant
Title: Mr Mrs Miss
Full name:
Address:
Ms Other
Full name:
Address:
Telephone:
Postcode:
Postcode:
Telephone:
Details of the Proposed Licence Holder,
if different from applicant
Details of the Manager/Managing Agent,
if applicable
Postcode:
Title: Mr Mrs Miss Other
Full name:
Address:
Telephone:
Ms
I confirm that the above property does not require a HMO licence.
Name(please print) :
Date:
Signature: Interest in property:
If the proposed licence holder is NOT the
person having control of the property, the
person having control of the property and the
proposed licence holder MUST sign the
following declarations...
I consent to being named as the
proposed licence holder of the above
named property
.
Name:
(please print)
Signature:
Date:
I, as the person having control of the
property, hereby give my consent to the
above named being licence holder.
Name:
(please print)
Signature:
Date:
Please remember that for a HMO to require a
licence it must meet the following criteria:
1) five or more persons forming more
than one household and;
2) live in the dwelling as their main or
only residence.
If all the criteria are met, please complete the
form as required. If any of the criteria are not
met, please complete the following declaration
and return the application form to the address
on the front of this form.
1.1
PART ONE - PERSONAL DETAILS
SECTION 1: DETAILS OF APPLICANT
The applicant must be a named individual
(see note 3)
1.2
1.3
Title:
Full name:
Residential address:
(see note 4)
Proof of address:
(see note 4)
Driving licence
Other
Bank statement
Utility bill
Business address:
(if applicable)
Postcode:
Proof of address:
(see note 4)
Business rates Utility bill
Home tel no: Mobile tel no:
Work tel no:
Fax no:
e-mail address:
Date of birth:
Interest in property:
Mr Mrs Miss Ms
Other
Postcode:
Owner
Manager Leaseholder
Other
Do you have control of the property?
(see note 5)
No
Yes
Are you the proposed licence holder?
(please go to question 2.2)
No
(please go to question 2.1)
Yes
SECTION 2: DETAILS OF PROPOSED LICENCE HOLDER
Postcode:
Mr Mrs Miss Other
Driving licence
Ms
The proposed licence holder must be a named individual
2.1
Title:
Full name:
Residential address:
Proof of address:
Business address:
Home tel no:
Work tel no:
Fax no:
e-mail address:
Date of birth:
Interest in property:
(see note 4)
(if applicable)
(see note 4)
(see note 3)
Bank statement
Utility bill
Other
Postcode:
Business rates Utility bill
Proof of address:
(see note 4)
Owner
Manager Leaseholder
Other
Mobile tel no:
2.2
If the proposed licence holder is part of a company, partnership, charity or trust, please
indicate which and provide contact details of all directors / partners / trustees - please
use additional sheet(s) if more than two. If not part of a company charity or trust, please
go to question 2.4.
Limited Company Partnership Charity Trust
Limited Company/partnership/charity/trust name:
Registered Company/Charity No:
Director Partner
Trustee
Director Partner
Trustee
Full name:
Full name:
Registered address: Registered address:
Postcode:
Postcode:
Telephone no: Telephone no:
Fax no: Fax no:
e-mail address: e-mail address:
Date of birth: Date of birth:
Postcode:
Mr Mrs Miss
Other
Ms
Please provide details of the Company Secretary/Senior Partner/Trust Secretary:
2.3
Title:
Full name:
Company Secretary
address:
Telephone no:
e-mail address:
Fax no:
Postcode:
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.
2.4
Name of person/company:
Correspondence address:
Telephone no:
e-mail address:
(see note 4)
Name:
(please print)
Signature:
Name:
(please print)
Signature:
Name:
(please print)
Signature:
Is the proposed licence holder a member of any landlord's association or other professional
body? Please indicate which.
2.5
Organisation
Since
Is the proposed licence holder an accredited landlord in this or another authority? Please indicate
and provide details of the scheme operator.
2.6
Authority Since
Please list training courses/conferences attended - relevant to property management - by the
proposed licence holder.
2.7
Training course Date
Scheme Operator
I, as a partner/trustee hereby give agreement to the above address being used for all
official correspondence and on the public register provided by
Redditch Borough Council
Fit and Proper Person
(see note 6)
The local authority must consider evidence whether the proposed licence holder, and any person
associated or formerly associated with them, whether on a personal, work or other basis is a fit and
proper person.
2.8
Has the proposed licence holder, or anyone associated with the proposed licence holder, ever accepted
a simple caution, previously known as a formal caution, from the Police or been convicted of an offence
(subject to the Rehabilitation of Offenders Act 1974)
involving any of the following?
2.9
2.10
2.11
Fraud
Dishonesty
Violence
Drugs
Sexual Offences Act 2003, Schedule 3
Sex
Colour
Race
Ethnic or national origin
Disability
Housing Law
Landlord and Tenant Law
Environmental Protection Act 1990
Public Health Law
Health and Safety Law
Building Regulation or Planning Laws
Housing Law
Landlord and Tenant Law
Environmental Protection Act 1990
Public Health Law
Proposed Licence
Holder
Yes No
Proposed Licence
Holder
Yes No
Proposed Licence
Holder
Yes No
Proposed Licence
Holder
Yes
No
Associate
Yes
No
Associate
Yes
No
Associate
Yes No
Associate
Yes No
Has the proposed licence holder, or anyone associated with the proposed licence holder, ever been
subject to unlawful discrimination proceedings relating to their business,
(subject to the Rehabilitation of
Offenders Act 1974)
involving any of the following?
Has the proposed licence holder, or anyone associated with the proposed licence holder, ever accepted
a simple caution, been convicted of an offence or been served with Statutory Notices under any of the
following?
Has the proposed licence holder, or anyone associated with the proposed licence holder, ever been
convicted for non-compliance of a Statutory Notice under any of the following?
Health and Safety Law
Building Regulation or Planning Laws
2.12
Proposed Licence
Holder
Associate
Yes No
Yes No
Control Order or Management Order
Where works have been carried out in default
A licence or registration certificate has been refused
Conditions of a licence or registration certificate have
been breached
Has the proposed licence holder, or anyone associated with the proposed licence holder, ever been in
control of a property subject to any of the following?
2.13
Proposed Licence
Holder
Yes No
Do you have the authority to repair and maintain the property and have the
financial arrangements necessary to repair the property?
Are you an undischarged bankrupt?
Are there any County Court judgments against you or any company of
which you are a director or secretary?
A licence holder must have the financial arrangements necessary to ensure the property is properly
managed and maintained. Please answer the following questions.
If you have answered 'yes' to any of the above questions, it is necessary for the Council to
undertake a further 'fit and proper person' check on the Proposed Licence Holder and anyone
associated with them. Please contact the Council on the telephone number below to request the
additional 'fit and proper person' form and return it to the address on page 1 together with this
application form.
Telephone No. 01527 64252
STATUTORY DECLARATION FOR RELEASE OF INFORMATION
To be completed by Proposed Licence Holder:
All information provided will be treated in confidence and in accordance with the Data Protection
Act 1998. It will only be used to progress your application.
As part of our duty under the Housing Act 2004 we may have to share and/or check your information with
other agencies including the Police, Fire and Rescue Service, Office of Fair Trading, other local
authorities and other relevant departments within this Council, for example Council Tax, Revenues and
Benefits and Debtors.
Please sign and date the declaration below in order for us to progress your application.
I, as the proposed licence holder, hereby authorise any statutory body holding
information about me, which falls within the categories above, to provide information
on request by the Council.
Name:
(please print)
Signature:
Date
SECTION 3: DETAILS OF MANAGER/MANAGING AGENT IF
DIFFERENT FROM PROPOSED LICENCE HOLDER
Postcode:
Mr Mrs Miss
Other
Driving licence
Ms
The proposed licence holder must be a named individual
3.1
Title:
Full name:
Residential address:
Proof of address:
Business address:
Home tel no:
Work tel no:
Fax no:
e-mail address:
Date of birth:
Interest in property:
(see note 4)
(if applicable)
(see note 4)
(see note 3)
Bank statement Utility bill
Other
Postcode:
Business rates
Utility bill
Proof of address:
(see note 4)
Owner
Manager Leaseholder
Other
Mobile tel no:
3.2
If the manager/managing agent is part of a company, partnership, charity or trust, please
indicate which and provide contact details of all directors / partners / trustees - please
use additional sheet(s) if more than two. If not part of a limited company, partnership,
charity or trust, please go to section 4.
Limited Company Partnership Charity
Trust
Limited Company/partnership/charity/trust name:
Registered Company/Charity No:
Director
Partner
Trustee Director
Partner
Trustee
Full name: Full name:
Registered address:
Registered address:
Postcode: Postcode:
Telephone no: Telephone no:
Fax no: Fax no:
e-mail address: e-mail address:
Date of birth: Date of birth:
Postcode:
Mr Mrs Miss
Other
Ms
Please provide details of the Company Secretary/Senior Partner/Trust Secretary:
3.3
Title:
Full name:
Company Secretary
address:
Telephone no:
e-mail address:
Fax no:
Postcode:
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.
3.4
Name of person/company:
Correspondence address:
Telephone no:
e-mail address:
(see note 6)
I, as a partner/trustee hereby give agreement to the above address being used for all
official correspondence and on the public register provided by
Name:
(please print)
Signature:
Name:
(please print)
Signature:
Name:
(please print)
Signature:
Is the manager/managing agent a member of any landlord's association or other professional
body? Please indicate which.
3.5
Organisation Since
Is the manager/managing agent accredited in this or another authority? Please indicate and
provide details of the scheme operator.
3.6
Authority Since
Please list training courses/conferences attended - relevant to property management - by the
manager/managing agent.
3.7
Training course Date
Scheme Operator
3.8
3.9
Fit and Proper Person
(see note 6)
Has the manager/managing agent, ever accepted a simple caution, previously known as a formal
caution, from the Police or been convicted of an offence
(subject to the Rehabilitation of Offenders Act
1974)
involving any of the following?
3.10
The local authority must consider evidence whether the manager/managing agent is a fit and proper
person.
Fraud
Dishonesty
Violence
Drugs
Sexual Offences Act 2003, Schedule 3
Sex
Colour
Race
Ethnic or national origin
Disability
Housing Law
Landlord and Tenant Law
Environmental Protection Act 1990
Public Health Law
Health and Safety Law
Building Regulation or Planning Laws
Housing Law
Landlord and Tenant Law
Environmental Protection Act 1990
Public Health Law
Health and Safety Law
Building Regulation and Planning Laws
Manager/Agent
Yes No
Manager/Agent
Yes
No
Manager/Agent
Yes No
Manager/Agent
Yes No
Has the manager/managing agent, ever been subject to unlawful discrimination proceedings relating to
their business,
(subject to the Rehabilitation of Offenders Act 1974)
involving any of the following?
Has the manager/managing agent, ever accepted a simple caution, been convicted of an offence or been
served with Statutory Notices under any of the following?
Has the manager/managing agent, ever been convicted for non-compliance of a Statutory Notice under
any of the following?
3.11
3.12
Has the manager/managing agent, ever managed a property, subject to any of the following?
Manager/Agent
Yes No
A Control Order or Management Order?
Where works have been carried out in default following service of a notice?
A licence or registration certificate has been refused?
Conditions of a licence or registration certificate have been breached?
If you do not hold a freehold interest or long lease with full repairing obligations, please answer the
following questions:
3.13
Manager/Agent
Yes No
Do you have the authority to carry out any works required to the property?
Is their any financial limitation on the amount of work you can carry out?
Please detail below the value of any work you can carry out without further authorisation and the
procedure which you must follow if works exceed this limit.
If you have answered 'yes' to any of the above questions, it is necessary for the Council to
undertake a further 'fit and proper person' check on the Manager/Managing Agent. Please contact
the Council on the telephone number below to request the additional 'fit and proper person' form
and return it to the address on page 1 together with this application form.
Telephone No. 01527 64252
STATUTORY DECLARATION FOR RELEASE OF INFORMATION
To be completed by Manager/Managing Agent:
All information provided will be treated in confidence and in accordance with the Data Protection
Act 1998. It will only be used to progress your application.
As part of our duty under the Housing Act 2004 we may have to share and/or check your information with
other agencies including the The Criminal Records Bureau, Police, Fire and Rescue Service, Office of
Fair Trading, other local authorities and other relevant departments within this Council, for example
Council Tax, Revenues and Benefits and Debtors.
Please sign and date the declaration below in order for us to progress your application.
I, as the manager/managing agent, hereby authorise any statutory body holding
information about me, which falls within the categories above, to provide information
on request by the Council.
Name:
(please print)
Signature:
Date
SECTION 4: DETAILS OF PERSON/ORGANISATION HAVING
CONTROL OF THE PROPERTY
Postcode:
Mr Mrs Miss
Other
Driving licence
Ms
4.1
Title:
Full name:
Residential address:
Proof of address:
Business address:
Home tel no:
Work tel no:
Fax no:
e-mail address:
Date of birth:
Interest in property:
(see note 4)
(if applicable)
(see note 4)
(see note 5)
Bank statement Utility bill
Other
Postcode:
Business rates
Utility bill
Proof of address:
(see note 4)
Owner
Manager Leaseholder
Other
Mobile tel no:
Contact name:
4.2
Are you the freeholder or the leaseholder?
freeholder
leaseholder
neither
PART TWO - PROPERTY DETAILS
SECTION 1: DETAILS OF PROPERTY TO BE LICENSED
To be completed for all properties requiring a licence
1.1
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 sketch plans for you at a charge.
EW
â
×
gas and
electric
meter
cupboard
Letting No.1
Letting No.2
Hall
Shared Kitchen
Utility
Room
Conservatory
Final exit to street
5 m.
4.5 m.
4 m.
1.5 m.
1 m.
5 m.
5 m.
4 m.
SD
AS
CP
SD
FD
FD
SD
AS
FD
DP
FD
FB
HD
CF
SH
WC
WHB
S
EL
Ø
Ù
Ú
Ø
×
Ø×
Ø×
Ø×
Ù
Ú
Ù
Ú
EXAMPLE GROUND FLOOR PLAN
Key of symbols to be used on plan
FD
Fire door
EW
Escape window
EL
Emergency lighting
CP
Manual call point
FAP
Fire alarm control panel
SD
Smoke detector linked to whole house
system
HD
Heat detector linked to whole house
system
AS
Alarm sounder linked to whole house
system
SA
Combined smoke detector/alarm,
may be linked or stand alone
HA
Combined heat detector/alarm,
may be linked or stand alone
FB
Fire blanket
WE
Water extinguisher
FE
Foam extinguisher
DP
Dry powder extinguisher
SH
Shower
B
Bath
WHB
Wash hand basin
C
Cooker
S
Sink
F
Fridge
NOTE: All fastenings to doors required for escape purposes must be thumb-turn type
locks, easily openable from the inside without the use of a key.
Sketch Plan
Notes
Sketch Plan
Notes
Sketch Plan
Notes
Sketch Plan
Notes
Sketch Plan
Notes
1.2 Please indicate the type of property to be licensed:
Detached Terrace
Semi-detached End terrace
Other
please indicate:
1.3 Please give approximate date of construction of the property:
Pre 1919 Post 1980
1919 - 1944
1945 - 1964
1965 - 1979
If the whole or part of the property has been converted, for example, into self-contained flats,
what was the approximate date of conversion:
Date:
1.4
1.5 Please provide details of any building works carried out to the property. Please include copies of
planning consents, building regulations approval or certificates issued on completion of works.
Description of works Date of completion
1.6 How many storeys are there in the property? Include basement and attic conversions but not
cellars.
(see note 7)
1 2 3 4 5 6 7 8 9 10
1.7 Over which levels are the storeys situated, such as ground floor, first floor, second floor?
(see note 8)
Basement First floor Third floor
Ground floor
Fourth floor
Other
Second floor
please indicate:
1.8 Is any part of the property used for separate commercial activity?
Yes No
If yes, please give details and location of the commercial activity below:
1.9
How many separate letting units (e.g self contained flats/bedrooms) are there in the property?
1
2.0
2 3 4 5 6 7 8 Other
How many households occupy the property at present?
(see note 9 for 'household' definition)
2.1
What is the maximum number of households that could occupy the property?
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
3.0
3.1
3.2
2.10
Please indicate the number of households you would like the licence for.
How many individual people occupy the property at present?
What is the maximum number of people who could occupy the property?
Please indicate the number of occupants you would like the licence for.
Is there a resident landlord?
Yes No
If no, please go to question 3.0
Is the proposed licence holder the resident landlord?
No
Yes
Number of people resident in the landlord's household, excluding the landlord?
Which rooms in the property are occupied by the resident landlord's household?
What form of heating is there in the bathroom/s? (for shared properties only)
Yes No
Radiator/s as part of the gas/oil fired central heating system
Individual wall-mounted electric heater/s
Other, please state:
What form of heating is there in the kitchen/s? (for shared properties only)
Yes No
Radiator/s as part of the gas/oil fired central heating system
Individual wall-mounted electric heater/s
Electric storage heater/s
Other, please state:
What form of heating is there in the common parts such as hallways and stairwells?
Yes
No
Radiator/s as part of the gas/oil fired central heating system
Individual wall-mounted electric heater/s
Electric storage heater/s
Other, please state:
Are there any gas appliances in the property?
Yes No If yes, please provide a copy of a valid gas safety certificate.
3.3
Please complete the following table indicating the facilities that are provided within the whole
dwelling by ticking the boxes relevant to indicate the facilities that each individual letting unit has
use of within the property.
(see note 10)
LETTING UNIT
1 2 3 4 5 6 7 8 9 10 TOTAL
FACILITIES
Number of people sharing unit
Number of bedrooms
Wash basin in property
- if shared property
Shared living room
Exclusive living room
Dining room
Shared kitchen/s
Exclusive kitchen
4-hob cooker, oven and grill
Microwave
Dedicated cooker point
Sink with drainer and base
unit
Refrigerator/s with freezer
compartment
Freezer
Shared bathroom/s with WC
and WHB
Shared shower room
- separate
Exclusive bathroom with WC
and WHB
Fixed heating such as gas
central heating
Electric storage heating
Other heating, non-portable
- please specify
SECTION 2: DETAILS OF FACILITIES AND MANAGEMENT
To be completed for all properties requiring a licence
4.1
Is there a system of fire detection incorporating:
Yes
No
a fire alarm control panel
sounders/alarms on all levels
emergency lighting in the common hallways
mains powered smoke/heat alarms in kitchen/common rooms
and hallways
4.2
battery operated smoke alarms
Is there a current fire alarm test certificate in compliance with BS5839 Part
1:2002, as amended by BS5839 Part 6:2004?
If yes, please provide a copy of the test certificate
4.3
Is a contractor employed to inspect and maintain the fire alarm system?
If yes, please state who:
4.4
Is there a current emergency lighting test certificate in compliance with
BS5266 Part1:1999?
4.5
4.6
4.7
If yes, please provide a copy of the test certificate
Are the kitchen(s)/kitchen areas protected by fire doors?
If yes, are they fitted with:
self closers
smoke seals
intumescent strips
Are all the doors that open onto the main escape route 30 minute fire resistant
doors that incorporate self-closers, smoke seals and intumescent strips?
If no, which doors are not:
Are the fire extinguishers provided and tested annually?
If yes, please state type and location:
Type of extinguisher Location of extinguisher
4.8
Is the escape route kept clear of flammable materials and other obstructions?
4.9
Are fire blankets provided in the kitchen/s
4.10
Does the property incorporate a sprinkler system?
4.11
If yes, please provide a copy
Is the main exit door openable from the inside without the use of a key?
Has a fire safety risk assessment been undertaken at the dwelling?
4.12
Yes No
Is upholstered furniture provided in the property?
4.13
If yes, does it comply with the Furniture (Fire Safety) Amendment
Regulations 1993?
DECLARATION OF APPLICANT AND PROPOSED LICENCE HOLDER
(see note 11)
PART THREE - DECLARATIONS
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 that you should have disclosed, or which has been incorrectly stated or described,
your licence may be cancelled or other action taken. Operating a 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 declare that the information provided in this application is true and correct to the best of my
knowledge. I understand that a criminal offence is committed if I supply any information to a
local housing authority in connection with this application for a licence of a House in Multiple
Occupation that is knowingly false or misleading and on conviction may be fined up to £5,000.
Name:
(please print)
Signature:
Date:
NOTE: If you are the applicant AND the proposed licence holder/manager you must sign all the
relevant sections below.
Applicant
Person having control of
the property
Proposed licence holder
Manager/managing agent
Name:
(please print)
Signature: Date:
Name:
(please print)
Signature: Date:
Name:
(please print)
Signature:
Date:
Enclosures
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
Evidence of permanent residential address of proposed licence holder
Building regulations completion certificate and planning consents, if applicable
Current fire alarm test certificate
Current emergency lighting test certificate
Service contract for alarm and safety systems
Current landlord's Gas Safety Certificate
Most recent periodic test certificate for the electrical installation
Most recent PAT certificate, if applicable
Fire safety risk assessment, if applicable
Licensing Fee. For fee and methods of payment , please see attached sheet
(as appropriate)
DECLARATION OF APPLICANT AND PROPOSED LICENCE HOLDER
You must let certain people know in writing that you have made this application, or give them a
copy of it, as follows:
any mortgagee of the property
any owner of the property to which this application relates, if that is not you, such as the freeholder,
and any head lessees who are known to you
any other person who is a tenant or leaseholder of the property or any part of it, including any flat,
who is known to you, other than a statutory tenant or other tenant whose lease or tenancy is of less
than three 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 will be bound by any condition or conditions in a licence, if it is
granted.
•
•
•
•
•
•
Your name, address, telephone number and e-mail address
the name, address, telephone number and e-mail addres of the proposed licence holder, if it will
not be you
•
•
You must tell each of these people:
that this is an application under Part 2 (Houses in Multiple Occupation) of the Housing Act 2004
•
the address of the property it relates to
the name and address of the local authority to which the application will be made
•
•
the date the application will be submitted•
I confirm that I have served notice of this application on the following people, who are the only
people known to me that are required to be informed that I have made this application.
Name:
(please print)
Signature: Date:
Name:
(please print)
Signature: Date:
Name:
Address:
Postcode:
E-mail address:
Interest in the property
or the application:
Date of service of Notice:
Name:
Address:
E-mail address:
Interest in the property
or the application:
Date of service of Notice:
Name:
Address:
Postcode:
E-mail address:
Interest in the property
or the application:
Date of service of Notice:
Name:
Address:
Postcode:
E-mail address:
Interest in the property
or the application:
Date of service of Notice:
Postcode:
Name:
Address:
Postcode:
E-mail address:
Interest in the property
or the application:
Date of service of Notice:
The following information is discretionary and you do not need to answer the questions. However,
if you do answer the questions it will assist the local authority in assessing their housing stock.
Ethnicity
of the
proposed
licence
holder
Asian/Asian British
Black/Black British
Chinese or other
ethnic group
Dual heritage
White
Indian
Pakistani Bangladeshi Other Asian
Caribbean
Chinese
Black Other Black background
White and
Black
Caribbean
White and Black
African
White and
Asian
British Irish Other
Other dual
heritage
background
How old is the bathroom?
How old is the kitchen?
Is there adequate noise insulation between the converted flats?
Does the property have cavity wall insulation?
Does the property have loft insulation?
If yes, what thickness is the insulation?
Any other ethnic group - please write in:
Yes
No
Yes
No
Yes
No
•
•
•
HOW TO FILL IN AN APPLICATION FOR
A HOUSE IN MULTIPLE OCCUPATION LICENCE
If you make any mistakes, or do not complete all the relevant sections, it may delay the processing of the
application form and incur further charges. If additional information is supplied on a separate sheet/s,
please make sure that they are securely attached to the application form. Please read the guidance notes
carefully to assist you in:
deciding if the property requires a licence
applying for the correct licence
completing the form correctly
enclosing all the relevant documents
•
From 6 April 2006, anyone who owns or manages a House in Multiple Occupation - HMO - that requires
a licence will have to apply for a Licence from the Local Housing Authority - LHA - in which the property is
situated. An application for a HMO Licence has to be made under Part 2 of the Housing Act 2004 which
has made it compulsory for local authorities to licence larger, high risk HMOs. Properties that are
operating without a licence will be subject to an offence that is liable to unlimited fines. The Act defines a
House in Multiple Occupation as a building or part of a building such as a flat that is:
occupied by more than one household and where more than one household shares - or lacks - an
amenity, such as bathroom, toilet or cooking facilities, or
a converted building - but not entirely self-contained flats - whether or not some amenities are shared,
or
converted self-contained flats, that do not meet the 1991 Building Regulations, and at least one third
of the flats are occupied under short tenancies
1.
2.
3.
Please note that there are two definitions concerning HMOs. The definition above is a general
HMO definition and is separate from the definition below which is used to determine if a HMO
requires a licence. If a HMO meets both definitions, please complete a mandatory HMO licensing
application form. If a HMO only meets the above definition, the HMO will not need a licence but
will still be subject to The Management of Houses in Multiple Occupation (England) Regulations
2006 and may require a Health and Safety Risk Assessment.
To make sure that the most vulnerable tenants living in the highest risk properties are protected, the
following definition as set out in The Housing Act 2004 makes it compulsory for certain HMOs to be
licensed, if:
1. it is occupied by five
or more persons comprising more than one household; and
2. the tenants are living in the dwelling as their main or only residence.
A
single household
refers to persons who are all members of the same family. A person is a member of
the same family if they are married to each other, live together as husband and wife including same sex
couples, and other relationships. A ‘relationship’ means parent, grandparent, child, grandchild, brother,
sister, uncle, aunt, nephew, niece or cousin. A relationship of the half-blood shall be treated as a
relationship of the whole blood and a stepchild shall be treated as his/her child. A person who lives in
accommodation supplied by his/her employer or by a member of his/her employer’s family, is classed as
living in the same household, for example, au pair, nanny, nurse, carer, governess, servants, chauffeur,
gardener, secretary or personal assistant.
Living accommodation occupied by persons as their main or only residence includes persons
undertaking a full-time course of further or higher education, migrant and/or seasonal workers and
asylum seekers or his/her dependents, who have been provided with accommodation under section 95 of
the Immigration and Asylum Act 1999(a) and the accommodation is provided under contract to, or on
behalf of, the National Asylum Support Service. It also includes HMOs that are operated as a refuge.
If the property falls into all of the above categories, it is a HMO that will require licensing under the new
national, mandatory HMO licensing scheme, introduced by the Housing Act 2004. There are different
types of licensing schemes that local authorities may operate in the area where your HMO is situated.
However, the application form relating to these guidance notes is for the mandatory scheme. Please
make sure that you are completing the correct application form.
NOTE 1
HOW IS THE HMO OPERATING
NOTE 2
holder. In normal circumstances, the Council
would expect the applicant to be the
owner/landlord of the dwelling and apply to be the
proposed licence holder. The proposed licence
holder must have the power to:
NOTE 3
•
•
•
•
collect rental income
let and terminate tenancies
access all parts of the dwelling
authorise repairs and maintenance to the
property
If this is the case, please complete all of section
one, following the instructions given within the
section. If the owner/landlord has nominated a
manager or managing agent to be the proposed
licence holder, they must have the power to
undertake the listed conditions such as collect
rental income and authorise repairs, in order for
the Council to assume that they are the most
appropriate person to hold the licence.
Please provide details of permanent residential or
business address of the applicant and/or proposed
licence holder - not the address of the HMO to be
licensed.
The full permanent residential address is required
together with the necessary supporting documents
to confirm the address. Evidence that will be
accepted by the Council as proof of address will
include one of the following:
NOTE 4
House converted and comprising only of self
contained flats
- A self-contained flat refers to a
dwelling where access is via a single front door
from any common area. Such dwellings would
contain all the standard amenities with no sharing
of amenities with the occupiers of neighbouring
dwellings. IF THE PROPERTY FALLS INTO THIS
CATEGORY, IT WILL NOT REQUIRE A
LICENCE. PLEASE SIGN THE DECLARATION
ON PAGE TWO AND RETURN THE FORM TO
THE COUNCIL.
Flat in multiple occupation
- Part of the building
is operating as a HMO either offering shared
facilities or bed-sit type accommodation - see
below for definition, or as a combination of
self-contained flats and bed-sits.
TYPE OF HOUSE FOR WHICH THE
APPLICATION IS BEING MADE
Supported lodgings
- Accommodation for young
people who live independently but have the
assistance of a carer whilst at the property
Bed-sits
- A term used to describe sleeping/living
arrangements that are not self-contained and
where there is shared use of some facilities such
as a bath or shower room, sanitary
accommodation or kitchen with the other
occupiers of the HMO.
Shared facilities
- Where the cooking and
washing/toilet facilities are shared between all
members of the HMO but each household has
their own sleeping facilities.
Household with lodgers
- A resident landlord
rents out rooms within the property. For this type
of property to be a HMO, there must be 3 or more
lodgers able to reside at the property at any one
time.
Hostel, B & B, guesthouse
- Accommodation for
people with no other permanent place of residence
who would otherwise be homeless.
RESIDENTIAL/BUSINESS ADDRESS
current driver’s licence
recent bank or building society statement - from
the last three months
recent utility bill - from the last three 3 months
recent tax correspondence
•
•
•
•
recent utility bill (from the last three 3 months)
business rates
recent tax correspondences
The supporting documents to confirm the business
address will include one of the following:
•
•
•
Photocopies of the above documents are not
accepted. Original documents must be sent with
the application form or alternative arrangements
made with the Council for original documents to be
verified. The Council has a duty to maintain a
public register and make sure that the contents of
the register are available at the authority’s head
office for inspection by members of the public at all
reasonable times. The permanent residential/
business address will be the address used on the
public register. If you would prefer an alternative
address to be used on the public register, please
complete section 2.4 in full in addition to providing
residential/business address.
DETAILS OF APPLICANT
The applicant must be a named individual
The applicant/proposed licence holder must be a
named individual and not a company. If a
House in multiple occupation
- The whole
property is operating as a HMO either offering
shared facilities or bed-sit type accommodation -
see below for definition, or as a combination of
self-contained flats and bed-sits.
company applies to be a licence holder, they must
nominate an appropriate person to hold the
licence within that company. The Council has a
duty to award the licence to the person it thinks is
the most appropriate person to be the licence
A person having control of the property in normal
circumstances is the legal owner/freeholder of the
property who receives the 'rack-rent' of the
premises. The 'rack-rent' means a rent which is
not less than two-thirds of the full net annual value
of the premises. In circumstances where the
owner/ freeholder has leased the property to
another person or company, the leaseholder will
become the person having control of the property.
NOTE 6
In deciding whether an application should be
granted, the Council must have regard to
evidence, which shows that the proposed licence
holder and/or manager and any other person
associated or formerly associated with them on a
personal, work or other basis is a fit and proper
person.
To make sure that the Council can adequately
assess whether a licence holder is a fit and proper
person a series of questions have been devised.
You must answer ‘yes’ or ‘no’ to all of the
questions in this section. If you answer ‘yes’ to any
of the questions, it will be necessary for the
Council to undertake a further assessment. You
must
contact the Council to request the additional
fit and proper person check. In accordance with
the Rehabilitation of Offenders Act 1974, you are
not required to provide details about previous
convictions that are ‘spent’.
A conviction becomes ‘spent’ after a certain length
of time, which changes depending on the
sentence and your age at the time of the
conviction. The periods are halved if the conviction
took place when you were aged 17 or less. If a
person is sentenced to more than two and a half
years in prison, his/her conviction can never
become ‘spent’.
Sentence
Period of good
conduct needed for
conviction to be spent
6 months to 2½ years
imprisonment
Less than 6 months'
imprisonment
Borstal Training
A fine or Community
Services Order
Probation Order,
Conditional Discharge,
or Bind Over
An Absolute Discharge
10 years
7 years
7 years
5 years
1 year
6 months
If you have any doubts about whether you have to
declare a previous conviction, you should contact
your local Probation Office, the Citizens' Advice
Bureau, or a Solicitor.
FIT AND PROPER PERSON
To enable the Council to be satisfied that the
information given is correct, please sign the
declarations as requested. This also ensures that
in certain cases other authorities such as the
Police Authority can be consulted during the
licensing process. If the declaration is not signed,
the application cannot be processed.
NOTE 5
CONTROL OF THE PROPERTY
Therefore, all unspent convictions must be
declared. Figure 1 indicates the period required for
the conviction to become spent.
FIGURE 1
Any information given will be treated as
confidential and used only in connection with this
application.
NOTE 9
A
s
ingle household
refers to persons who are all
members of the same family such as, married and
co-habiting couples of the opposite and same sex,
and other relationships. A ‘relationship’ means
parent, grandparent, child, grandchild, brother,
sister, uncle, aunt, nephew, niece, cousin,
relationship of the half-blood and stepchild.
Additionally, a person living with his/her employers
family or in accommodation supplied by his/her
employer is classed as living in the same
household, such as, au pair, carer, gardener or
personal assistant.
NOTE 10
Wash
basin in property
- if shared property
Other heating,
non-portable
- please specify
Number of people
sharing unit
N
umber of bedrooms
Shared living room
Exclusive
living room
Dining room
Shared kitchen/s
Exclusive kitchen
4-hob cooker, oven
and grill
M
icrowave
Dedicated cooker point
Sink with drainer and
base unit
R
efrigerator/s with
f
reezer compartments
Freezer
Shared bathroom/s with
WC and WHB
Shared shower room
- separate
Fixed heating such as
gas central heating
Electric storage heating
LETTING UNIT
Exclusive
bathroom with
WC and WHB
FACILITIES
1
2 3 4 5 6 TOTAL
1 1 1 1 1
1 1 1 1 1
0 0 1 0 1
üüüüü
üüüüü
üüüüü
üüüüü
üü
üüü
üü
üüü
üüüüü
üüüüü
üüüüü
üüü
5
5
2
1
1
1
1
1
1
1
1
1
HO
USEHOLDS
FACILITIES AVAILABLE FOR EACH
INDIVIDUAL LETTING
The table for facilities in Part 2 has been designed
to allow information to be given for shared and
self-contained properties.
It is a ‘tick box’ table to
make sure that for each individual letting they have
access to certain facilities. If any of the listed
facilities are not contained within the property,
please leave the box blank. Using the example
opposite (Figure 2) please complete the table in
Part 2.
DECLARATION OF APPLICANT AND
PROPOSED LICENCE HOLDER
Please complete all the necessary declarations at
the end of each relevant section. The final
declaration indicating that all the information
c
ontained within the application form is true and
correct requires signatures by all persons who
have completed Part 1. If the applicant is also the
proposed licence holder, please sign both the
applicant and proposed licence holder sections as
indicated in Part 3.
NOTE 11
FIGURE 2
It is a criminal offence to
knowingly
supply
information that is false or misleading for the
purposes of obtaining a licence. Under Section
238 of the Housing Act 2004, a person who
commits an offence is liable on summary
conviction to a fine not exceeding level 5 on the
standard scale (up to £5,000).
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APPLICATION FOR HMO LICENCE HOUSING ACT 2004 To (Bromsgrove District Council)

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Completed 19 January 2021

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