Forms home HMO welfare audit Are you asking for help for yourself or for someone else?(Required)MyselfSomeone elseFirst name(Required)Last name(Required)Address(Required) Street Address Address Line 2 City AberdeenshireAngus/ForfarshireArgyllshireAyrshireBanffshireBedfordshireBerkshireBerwickshireBlaenau GwentBridgendBuckinghamshireButeshireCaerphillyCaithnessCambridgeshireCardiffCarmarthenshireCeredigionCheshireClackmannanshireConwyCornwallCromartyshireCumberlandDenbighshireDerbyshireDevonDorsetDumfriesshireDunbartonshire/DumbartonshireDurhamEast Lothian/HaddingtonshireEssexFifeFlintshireGloucestershireGwyneddHampshireHerefordshireHertfordshireHuntingdonshireInverness-shireIsle of AngleseyKentKincardineshireKinross-shireKirkcudbrightshireLanarkshireLancashireLeicestershireLincolnshireLondonMerthyr TydfilMiddlesexMidlothian/EdinburghshireMonmouthshireMorayshireNairnshireNeath Port TalbotNewportNorfolkNorthamptonshireNorthumberlandNottinghamshireOrkneyOxfordshirePeeblesshirePembrokeshirePerthshirePowysRenfrewshireRhondda Cynon TaffRoss-shireRoxburghshireRutlandSelkirkshireShetlandShropshireSomersetStaffordshireStirlingshireSuffolkSurreySussexSutherlandSwanseaTorfaenVale of GlamorganWarwickshireWest Lothian/LinlithgowshireWestmorlandWigtownshireWiltshireWorcestershireWrexhamYorkshire County Postcode Contact number(Required)Email address(Required) Why are you self isolating? Over 70 Under 70 with underlying health conditions Showing symptoms Pregnant Instructed to do so by the NHS by letter or text What do the vulnerable persons at the property need help with?(Required) Threat of eviction Rent issues Essential repairs Safety at the property Urgent food deliveries Medication collection Isolation or loneliness Essential repairs may include issues with heating, hot water, damp and mould, fire safety, electrical safety, gas safety, security at the property and overcrowding.What other help, if any, is required?How many rooms are used for sleeping?(Required)How many people are living at the property?(Required)How many separate households live at the address?(Required)Property owner or landlord name and contact detailsManaging agent name and contact detailsWe are using local organisations working in communities to help support some services. Please confirm if you are happy for us to share your details with 3rd party organisations. I am happy for my details to be shared with select supporting organisations We process all personal information securely and in accordance with current data protection legislation. Find information on how we process your data on our privacy notice or you can write to our Information Governance Team at email@example.com.