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Do you live in a Council or Housing Association property?*

Yes

No

What disrepair issues do you have?*

Damp/Mould

Defective Heating or Electrics

Crumbling Plaster

Faulty Windows

Active Leaks

Defective Roofing

Internal or External Brickwork

Drains, Gutters and External Pipes

Other

Have you reported the disrepair to your landlord?*

Yes

No

Have you made a claim before?*

Yes

No

Name*

First Last

Email*

Phone*