Rent to rent form • LSK Risk Management

Have you had insurance or a proposal cancelled, withdrawn, declined or made subject to special terms? *

Have you been declared bankrupt or become insolvent or made any voluntary arrangement with creditors or been subject to enforcement of a judgement debt either in a personal capacity or as a business? *

Have you been convicted of or charged with any offence (including a civil penalty from the UK Border Agency), other than a motoring offence or conviction spent under the Rehabilitation of Offenders Act 1974? *

Name of company (ltd company, individual or partnership) *

Correspondence address *

Address of properties (list each property below) *

Number of bedrooms (list each property below) *

Value of contents (list each property below) *

Please list if properties are HMO/Serviced accommodation *

Flat/house - terraced/semi (list each property below) *

Contact name *

Contact number *

Contact email *

Please confirm for our due dilligenge *

Agree
Disagree

- No claims for professional negligence, error or omissions or the like have ever been made against the - Firm or any predecessor(s) in business or against any Partners / Directors / Principals either directly or in respect of any company of which they were a Partner / Director / Principal of. - After enquiry within the Firm, the Proposer is not aware of any circumstances which have occurred which may give rise to a claim. - The Firm or any Partners / Directors / Principals has not had any insurers decline to offer Professional Indemnity renewal terms, nor has had their Professional Indemnity Policy cancelled or voided, or had any special premium increase or special terms being imposed due to a material fact. - The Firm or any Partners / Directors / Principals do not act, or have not acted, in any capacity other than those declared. - The Firm or any Partners / Directors / Principals have not ever been the subject of investigations or disciplinary proceedings by any regulatory body or the Health & Safety Executive. - The Firm or any Partners / Directors / Principals do not undertake work for any Partnership, Company or Organisation in which they are in a position to exercise a controlling interest in such a Partnership / Company / Organisation. - This company does not provide any investment advice.