Proof Of Rent Certificate Page 2
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1
2Water rates
No
Yes
How much?
£
Heating the home
No
Yes
How much?
£
Lighting the home
No
Yes
How much?
£
Hot water
No
Yes
How much?
£
Cooking
No
Yes
How much?
£
Cleaning shared areas
No
Yes
How much?
£
Lighting shared areas
No
Yes
How much?
£
Heating shared areas
No
Yes
How much?
£
A lift
No
Yes
How much?
£
Warden, caretaker, porter
No
Yes
How much?
£
Gardening
No
Yes
How much?
£
Laundry service
No
Yes
How much?
£
Laundry facilities
No
Yes
How much?
£
Cleaning the home or windows
No
Yes
How much?
£
General counselling and support
No
Yes
How much?
£
Alarm
No
Yes
How much?
£
Nursing or personal care
No
Yes
How much?
£
Other services
No
Yes
How much?
£
What for?
Use the box below if there is any other information about your property, or the rent that your tenant
has to pay, that you would like to tell us about.
DECLARATION
I confirm that the above information is correct and complete
I understand that I must let you know straight away if any of my tenant’s circumstances change.
Landlord’s or agent’s
Date
/
/
signature
Please return this form to:
Peterborough City Council
Benefits Service, Town Hall
Bridge Street
Peterborough
PE1 1BF tel. 01733 747474
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