Housing Claim Form

Completion of this form and its submission to Stirling Council cannot be construed as binding the Council in liability to the claimant.

Consent

I give permission to store and process my data *

Claimants details

Name *

Telephone

Email *

Date of birth *

First line of address *

Please enter first line of address including house no

Town *

Please enter Town

Postcode *

Please enter Postcode

Are you submitting a claim on behalf of someone else?

Yes

Incident date: *

Incident time:

Street *

Please enter Street details

Town 1 *

Please enter Town

Postcode 1 *

Please enter Postcode

Incident Details

Where exactly did the incident occur?

Describe the incident and how it occurred?

When was the Council first made aware of the alleged defect/problem?

What was done to rectify the problem?

please include time/date

In what way do you consider the Council or its employees have been at fault?

If the loss arises from involvement with a contractor, please give details.

Loss or damage to property

Describe item, where purchased, date of purchase, price paid, estimated cost of replacement

5 4 3 2 1