Married Single Separated Divorced Widowed Living together. Property owner Council tenant Private tenant Living with parents/relatives

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Head Office 8 Wellington Street Luton Bedfordshire, LU1 2QH Luton Tel. 01582 616263 Fax. 0870 0941773 Dunstable Tel. 01582 543680 Fax. 0870 0941774 Northampton Tel. 0845 1303635 Fax. 0870 0941775 Bedford Tel. 01234 272662 Fax. 0870 1623902 www.lenwell.com R E F E R E N C I N G S E R V I C E 1502881 1. P R O P E R T Y D E TA I L S LETTING AGENT Date Reference Received Application ref. Property ref. of property applied for Total rent for this property: per month Total rent for this applicant: per month Is the property shared? Yes No If yes, number of sharers in the property: Is this a student property? Yes No If yes, use the Student Guarantee Application. Tenancy term: years months Tenancy start date: 2. T E N A N T D E TA I L S Title: First name: Initials: Surname: Other name(s): Date of birth: Married Single Separated Divorced Widowed Living together 3. C U R R E N T A D D R E S S O F T H E P R O S P E C T I V E T E N A N T Period at address: years months Email: Telephone: Mobile: Property owner Council tenant Private tenant Living with parents/relatives Have you any County Court Judgments, court decrees, bankruptcy or administration orders? Yes No If yes, please detail on a separate sheet. Agent no.: 1502881 Page no.: 1 of 6

4. P R E V I O U S A D D R E S S E S O F T H E P R O S P E C T I V E T E N A N T Where have you been living during the last 3 years? Please provide previous address(es) and dates of residency (over 3 months), attaching a separate sheet if necessary. 2 Period at address: years months 3 Period at address: years months 5. CURRENT ESTATE AGENT/ SOLICITOR/ MANAGING AGENT/ LANDLORD Name of estate agent/solicitor/managing agent/landlord (delete as appropriate) Tel (day): Tel (evening): Fax: Email: 6. T E N A N T S E M P L O Y M E N T S TAT U S Employed Self employed On contract Retired Unemployed Student Independent means Proof is required if you tick this box. Details of current employer/pension administrator/accountant/auditor/solicitor (delete as appropriate) Company name Contact name/position Fax: Email: Gross salary/pension/drawings (delete as appropriate) per annum Payroll/service/pension number Position held: Starting date in this position: Is this position permanent? Yes No Will your employment change before the proposed tenancy starts? Yes No If yes, please detail on a separate sheet. Agent no.: 1502881 Page no.: 2 of 6

7. T E N A N T S P R E V I O U S E M P L O Y M E N T / O C C U PAT I O N If you have not worked in your current position for at least 18 months, please provide details of where you have previously wor employment (attach a separate sheet if necessary). ked, including dates of joining and leaving Company name Fax: Starting date in this position: Finishing date in this position: 8. T E N A N T S O T H E R I N C O M E ( I F A P P L I C A B L E ) Pension per annum Investment income per annum Income support per week Other (please specify) 9. B A N K / B U I L D I N G S O C I E T Y A C C O U N T D E TA I L S Bank / building society name Current account only Account number Account name Bank sort code 1 0. P E R S O N A L R E F E R E N C E This should not be a relative or anyone else named on this application. Name: Relationship Agent no.: 1502881 Page no.: 3 of 6

1 1. N E X T O F K I N This should not be your spouse. Name: Relationship 1 2. A D D I T I O N A L I N F O R M AT I O N Use this space to provide any additional information we may have requested. If you run out of space, please use a separate sheet. Agent no.: 1502881 Page no.: 4 of 6

1 3. I N D I V I D U A L S D E C L A R AT I O N Please read the declaration and sign below. WE CANNOT PROCEED WITH THIS APPLICATION IF YOU DO NOT SIGN. I enclose including VAT (additional tenants charged at 50 each) to cover administration costs for the property above I have read the Tenant s Charter (a copy of which is overleaf). The information completed is correct and if required references may be taken. In accordance with the Tenant s Charter. I understand I will lose all monies paid to if I withdraw from the proposed tenancy. I understand all negotiations are subject to contract and if I have any further requirements or requests I will put them in writing to my manager. I also understand any refund due to me will be paid within ten working days of my written request and sent to me by cheque. I hereby confirm that the information provided by me is to the best of my knowledge true. I consent to this information being verified by contacting the third parties detailed in this form. I understand that the results of the findings will be forwarded to the and/or landlord and may be accessed again should I default on my rental payment or apply for a new tenancy agreement in the future. I agree that HomeLet or their approved agent may search the files of a Credit Reference Agency and IDS Ltd, the insurance industry's data collection agency, which will keep a record of that search. I confirm and agree that other information and checks that HomeLet and/or other companies within the same group undertake as part of this process, such as employment/income and/or previous landlord or personal checks may also be provided to Credit Reference Agencies. I understand that I may request the name and address of the Credit Reference Agency to whom I may then apply for a copy of the information provided. I also understand that in the event of my defaulting on the rental payment, that any such default may be recorded with the Credit Referencing Agency and IDS Ltd, who may supply the information to other credit companies or insurers in the quest for the responsible granting of tenancies, insurance and credit. I understand that HomeLet utilise the services of Credit Reference Agencies, and I consent to HomeLet checking details held within those agencies for Tenant Vetting, Fraud Prevention, Identity and Anti-Money Laundering and also for the purposes of collections and recoveries where applicable. I understand that in the event of any default by me in respect of the covenants in my tenancy agreement with my landlord, the information contained herein may be disclosed to HomeLet and/or one or more tracing companies and/or debt collection agencies in order to recover any monies due or to trace my whereabouts. I understand that the information provided by me may be transferred to a country outside of the EU for the purposes only of processing this referencing application, notwithstanding such transfer, HomeLet will remain the Data Controller for the purposes of this application. The information provided in this form by me is information as described in Ground 17 of the Housing Act 1996 and I understand that if any information within this application is found to be untrue, it is grounds for termination of the tenancy. I also understand that any default in the payment of rent may affect any future application for tenancies, credit or insurance and that the assessment of this application presumes that at some time during the tenancy agreement, I may be granted or allowed some form of deferred payment. I hereby authorise my employer / accountant / pension administrator (delete as appropriate) to provide details of my earnings and dates of employment to HomeLet for the purposes described above. Signed Print name in full Date The details you provide will be held by HomeLet and the letting agent and may be used to keep you up to date on our products and services and those of Hanover Park Services Limited, Barbon Insurance Group and other organisations we believe will be of interest to you. If you prefer not to receive this information, please tick this box HomeLet is a trading name of Barbon Insurance Group Limited and Hanover Park Services Limited. Barbon Insurance Group Limited is authorized and regulated by the Financial Services Authority. Registered in England number 3135797. Registered Office : 4-9 Highview, High Street, Bordon, Hampshire GU35 0AX. Hanover Park Services Limited is registered in England number 4194617. Registered office address 4-9 Highview, High Street, Bordon, Hampshire GU35 0AX.. HomeLet is a trading name of Hanover Park Services plc Registered address: Phoenix House, 11 Wellesley Road, Croydon, CR0 2NW Company Registration No: 04194617 Hanover Park Services plc is a member of the General Insurance Standards Council Agent no.: 1502881 Page no.: 5 of 6

Reference Number: DECLARATION AND CONSENT To be Please read the declaration and sign and date below This reference is being completed by HomeLet on behalf of your Letting Agent. HomeLet is part of the Barbon Insurance Group Limited. Barbon shall for the purposes of this application form be the Data Controller as defined in the Data Protection Act 1998 (the "Act"). Please read and complete the following declaration statement really carefully, making sure that you tick to say you understand how we re going to use your information. You should also sign and date the form in the space provided because we can t complete your application without this, and that could delay your application for a rented property. I understand that the information contained in this application will be retained, stored and used by HomeLet in accordance with the Data Protection Act. I confirm that the information I have provided is true and accurate to the best of my knowledge and agree that HomeLet can verify this through a number of different sources. These sources may include consulting the databases of credit reference agencies, the electoral roll, the Industry Sortcode Directory (ISCD) as well as other sources of information in relation to the details I ve provided. In connection with this application I also understand and consent that: HomeLet may contact me using the contact details provided in this application form, for the purpose of completing my reference; HomeLet may pass on any information I have supplied and the results of any linked verification checks to my letting agent and/or any appointed landlord; If I default on my rental payment or apply for a new tenancy agreement in the future HomeLet may review the results of the verifications and searches set out above; If I default on paying my rent the default may be recorded on HomeLet's central database for defaulting tenants and that such default may affect any future application I may make for tenancies, credit and/or insurance; HomeLet can use debt collection agencies or tracing agents to trace my whereabouts and recover any monies I owe to HomeLet I understand that by consulting with a Credit Reference Agency, the Agency will keep a record of this search, and that the results of this search may show how I conduct my payments with other organisations. I also understand that how I conduct the rental payments as part of this tenancy may be disclosed to the Agency and may affect future credit applications. From time to time this information may also be used for debt tracing and fraud prevention. I also understand that I may request the name and address of the Credit Reference Agency HomeLet use, and that I may apply for a copy of the information they provided to HomeLet* I hereby authorise my referee/s to provide details of my earnings/ dates of employment / previous tenancy term (if appropriate) to HomeLet for the purposes described above for the completion of my application for a rented property * I understand that by ticking this box I am giving HomeLet consent to contact me directly by telephone or post, and hereby give them permission to use my information to provide me with details about their services which include specialist insurance for tenants which can cover my liability as a tenant as well as my personal contents I agree that HomeLet may send me information about their specialist products and services by email or SMS, which may include a personalised quote for specialist Tenant s Insurance, which if I choose to, I may contact HomeLet directly for more information on this and to take out cover Please note that if you wish to find out more about any of the sources of information that we access to complete your application then this can be found at http://www.homelet.co.uk/ref-info. If you d like to unsubscribe from any services at any time then please contact HomeLet on unsubscribe@homelet.co.uk. Signed Name Dated * Please note, that if you do not tick these boxes, we will be unable to complete your application HomeLet is a trading name of Barbon Insurance Group Limited. Barbon Insurance Group Limited is authorised and regulated by the Financial Services Authority. Registered in England number 3135797. Registered office address: 4-9 Highview, High Street, Bordon, Hampshire GU35 0AX. Feb 2012

S CHA RTER This charter is here to assist tenants and make them aware of their position as regards LENWELL. Where LENWELL is the appointed agent of the LANDLORD no contract can exist between the and LENWELL. However, the following matters are dealt with by LENWELL on behalf of the LANDLORD and directly affect the. 1. Administration costs Upon a prospective being provisionally accepted by the LANDLORD and the property being withdrawn from the market an administration fee is payable by the tenant for the costs LENWELL incur to obtain references and prepare the tenancy agreement. In the event that the tenant withdraws from the proposed tenancy a further charge of 50% of the fi rst months rent plus VAT is also payable to LENWELL. This charge represents the reasonable costs LENWELL have incurred in marketing the property, arranging viewings and withdrawing the property from the market. 2. References Where, for whatever reason, the tenancy does not proceed any references undertaken by LENWELL remain the property of LENWELL. These will be released to the prospective upon receipt of an administration fee, although LENWELL accept no liability for the accuracy of such references so obtained. 3. Deposit and 1st month s rent Prior to moving into the property the (prospective) is normally required to pay one month s rent and a deposit of one month s rent (i.e. 2 month s rent) in advance in cleared funds, although the amount may vary in individual cases. The deposit is held by LENWELL as a stakeholder. This means that at the end of the Tenancy and any Statutory Tenancy which may arise thereafter this money will only be released by agreement of both the LANDLORD and the. In the event of dispute between the LANDLORD and the LENWELL offer arbitration services; alternatively arbitration is available through the Association of Residential Letting Agents (ARLA). Deposits held by LENWELL are protected by a Guarantee Bonding Scheme (now known as a Fidelity Bond ) insured through ARLA. As a contribution to the administration costs any interest earned on deposits is retained by LENWELL. 4. Moving in Prior to the (prospective) being allowed to move into the property a Tenancy Agreement must be signed by both the and the LANDLORD and LENWELL must be in receipt of cleared funds from the as referred to in paragraphs 3 and 6. Until the Tenancy Agreement has been signed by the LANDLORD and the tenant and the funds have cleared the has no right to occupy the property. 5. What you see is what you get Unless the has confi rmation in writing from LENWELL to the contrary, signature of the Tenancy Agreement is acknowledgement that the Agreement contains the whole agreement between the parties and that the has not relied upon any oral or written representation made by the LANDLORD or LENWELL. Particular attention should be paid to the inventory and state of condition and the tenancy agreement. 6. Cleared funds Where the prospective is paying by cheque this normally takes 5 working days to clear. Cash, bankers drafts and printed Building Society cheques are cleared immediately. 7. Refunds Where, for whatever reason, the is due a refund of any monies paid then LENWELL will return these to the by post or to the s bank account within 10 working days of written request from the tenant for such and notification of the address or Bank, branch and account to which this should be sent. Alternatively the (prospective) may wish LENWELL to use these monies to cover the cost of arranging alternative accommodation. It must be appreciated that where the monies in question are the deposit held under the Tenancy Agreement no refund is due unless and until agreement has been reached between the parties as to such. Any interest earned upon monies held by LENWELL during the course of any Tenancy will be retained by LENWELL to offset the administration costs of such. Where monies are held by LENWELL past the end of the Tenancy or where no Tenancy Agreement is ever entered into LENWELL reserve the right to charge for the reasonable administration costs of such, limited to a maximum sum of the interest earned during the said period. WHERE THE PROPERTY IS MANAGED BY LENWELL THE FOLLOWING ALSO APPLIES: 8. Payment of rent Rent is payable and must be cleared, on or before the rent due date under the tenancy agreement. Cheques should be made payable to LENWELL and payment should be made either by post, by hand or by standing order at or to any of LENWELL s offi ces, although receipts are not provided unless payment accompanied by a stamped addressed envelope or is made in person. 9. Arrears of rent If the rent falls into arrears LENWELL send a reminder letter to the free of charge. Where the rent remains outstanding for more than seven days from the rent due date LENWELL send a further reminder to the and notify the LANDLORD of such; ho wever the is liable for all of the administration costs thereby incurred. In the event that the rent continues to remain unpaid for more than 21 days from the rent due date LENWELL send a further reminder to the, advise the LANDLORD of the situation and refer the matter to LENWELL s Solicitors. The is again responsible for all the costs thereby incurred. It must be appreciated that late payment of rent is a breach of the Tenancy agreement and may result in legal action and possession proceedings being taken at the tenants expense. 10. Inspections The property is normally inspected by LENWELL on a quarterly basis, ho wever this may be more frequent in exceptional cases. In any event, LENWELL will provide the with written notice at least 48 hours in advance of any inspection. Where notice is served by post this shall be by fi rst class post sent to the property and the notice is deemed to be served 48 hours after posting. 11. Problems Where the tenant has any problems with the property whatsoever the tenant should contact LENWELL in writing forthwith or in emergency by telephoning 01582 658000 where a message can be left if out of hours and emergencies will be dealt with on a priority basis. References to the singular include the plural and vice versa. References to LENWELL mean LENWELL Limited registered offi ce 8 Wellington Street Luton Bedfordshire LU1 2QH. References to mean prospective S where applicable. LENWELL Limited 1994. All Rights Reserved. Ref:TC.01\IDR:105\04/94