A. PARTICULARS OF COMPLAINANT:(LANDLORD / TENANT)
Title ________ Name __________________________________ID Number ____________________
Address ___________________________________________________________________________
Postal Address _____________________________________________________________________
Postal Code__________
Tel (H) ______________________ (W) ___________________(Cell) _________________________
Fax _________________________
E-mail __________________________________________
B. PARTICULARS OF RESPONDENT: (LANDLORD / TENANT)
Title ________ Name __________________________________ID Number ____________________
Address ___________________________________________________________________________
Postal Address _____________________________________________________________________
Postal Code__________
Tel (H) ______________________ (W) ___________________(Cell) _________________________
Fax _________________________
E-mail __________________________________________
C. PARTICULARS OF RENTAL AGENT:(PLACEMENT / MANAGING)
Name _______________________________ Name of Company ____________________________
Tel (w) _________________________ (cell) _______________________ Fax _________________
E-mail _______________________________
Address _________________________________
______________________________________________________________Postal Code__________
Mandate / responsibilities of agent ______________________________________________________
__________________________________________________________________________________
Case Number H10/3/3/1/ /
COMPLAINT FORM FOR THE RENTAL HOUSING TRIBUNAL
D. PROPERTY IN DISPUTE
Has a complaint for this property been submitted before?
Description of property:
House / Flat / Room / Garage / Hostel / Room / Other (specify):
Address __________________________________________________________________________
________________________________________________