Complaint Form

Complainant's Details
Tenure * Required
Title * Required
Forename(s) * Required
Surname * Required
Address * Required
Address Line 1 Address Line 2 Address Line 3 Address Line 4 Post Code
Phone * Required
Mobile * Required
Email * Required
Preferred contact method * Required
Who is making this complaint? * Required
- I am the complainant
- I am a representative
Accessibility and practical needs?
Other special requirements

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Representative's Details
Relationship with complainant * Required
Title * Required
Forename(s) * Required
Surname * Required
Job Title * Required
Organisation * Required
Address * Required
Address Line 1 Address Line 2 Address Line 3 Address Line 4 Post code
Telephone number * Required
Mobile number * Required
Fax number * Required
Email * Required
Website * Required
Reason for representation * Required
Is the Representative/Joint Complainant to be the primary point of contact? * Required
- Yes
- No
Is this a group complaint? * Required
- Yes
- No

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Complaint Details
Who is your Landlord? * Required
My complaint is about * Required
When did you first report this issue? * Required
MM slash DD slash YYYY
When did you make a formal complaint? * Required
MM slash DD slash YYYY
How have you been affected? * Required
0 of 1000 max characters
What has the landlord done since you first submitted your complaint? * Required
0 of 1000 max characters
What do you think the landlord should do to put the matter right? * Required
0 of 1000 max characters
* Please note that you will no longer be able to 'Save til later' upon proceeding past this page.

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Monitoring information

Please note that there is a 'prefer not to say' option on each question below if you don't wish to provide the following information.
Ethnicity: How would you describe your ethnic origin? * Required
Gender: What is your sex? * Required
Sexuality: Do you identify as: * Required
Marital status: Are you married or in a civil partnership? * Required
Religion: Please indicate your religion, practice or belief: * Required
Age: Please indicate your age: * Required
Disability: Do you consider yourself to have a disability? * Required
Disability Notes * Required
0 of 1000 max characters
If you have none, please fill in not applicable.

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Review Submission