Application for a Temporary Exemption to licence for a licensable house in multiple occupation (HMO) issued under Part 2 of the Housing Act 2004

Please complete this form if you believe your property does not require a licence under Part 2 of the Housing Act 2004 (the Act). You must complete this form fully; do not leave any lines blank.  Please note that it is a criminal offence to be managing or in control of a House in Multiple Occupation that is required to be licensed and is not so licensed. A separate application must be made for every property that requires a temporary exemption notice. If you require any assistance in completing this form, or you require additional forms, please contact the Housing Standards team on 01223-457900 or by e-mail at env.health@cambridge.gov.uk
There is no fee payable for a Temporary Exemption Notice application.

Section One: Owner Details	
Title:
		Date Of Birth:		
Forename(s):	
	Surname:		
Address:	
                                                   Post Code:	
Telephone/Mobile:	
	
E-Mail/ Fax:	

Section Two: Manager/ Managing Agent Details	
Title:
		Date Of Birth:		
Forename(s):	
	Surname:		
Address:	
                                                   Post Code:	
Telephone/Mobile:	
	
E-Mail/ Fax:	

Section Three: Details of licensed property 
	
Address of property:

                                         Post Code:	
Are you the registered property owner?	
              YES:                        NO:	
If No, please supply the owner’s name and address :	

                                           Post Code:	
Date the current licence was issued. 	

Supporting Information:	
Please provide a detailed explanation supporting your application for a Temporary Exemption Notice.  Evidence may be required in support of any statements made for example copy of death certificate, evidence of planned improvement work and timescales. Please note we reserve the right to carry out additional checks in support of your application within the Council and with other agencies as appropriate.  Please attach additional sheets, if necessary. 	

	

Conditions of Temporary Exemption Notice

If a Temporary Exemption Notice is served on a property specified in Section 3 of this Application Form, the property will not require a licence during the period in which the notice is in force.

A Temporary Exemption Notice is in force for a period of three (3) months beginning on the date that it is served. Cambridge City Council, upon receipt of a second application, may consider issuing a second Temporary Exemption Notice for a further period of three months if they consider that there are exceptional circumstances. The second notice would take effect from the end date of the first notice.  

The grounds for temporary exemption from mandatory HMO licensing are stated in the Housing Act 2004, Part 2, Section 62.

If it is decided not to serve a Temporary Exemption Notice in response to an application the applicant will be informed of: 

a)	the decision, 
b)	the reason for the decision and the date on which it was made,
c)	the right to appeal against the decision,
d)	the period within which an appeal may be made.

The person concerned may appeal to the Residential Property Tribunal against the decision within a period of 28 days beginning on the date that the refusal was made.

Section Four : Declaration

Note To Applicants:

Please note that it is criminal offence to knowingly supply information, which is false or misleading for the purposes of obtaining a Temporary Exemption Notice.  If it later transpires that you have omitted any relevant information to support your application or you have made any false statements or misrepresentations, the temporary exemption notice may be refused and other appropriate action taken

Declaration:

I/we declare that the information contained in this application is correct and to the best of my/our knowledge. I/we understand that I/we commit an offence if I/we supply any information to a local housing authority in connection with any of their functions under any of Parts 1 to 4 of the Housing Act 2004 that is false or misleading and which I/we know is false or misleading or I/we are reckless as to whether it is false or misleading.

I/we understand that should any circumstance referred to in this application change, that I/we must inform Cambridge City Council as soon as is practicable. I/we understand that information supplied with this application will be stored in accordance with the principles of The Data Protection Act 1998 and will only be shared with other relevant bodies, including other local authorities and Government Agencies, where legally necessary.

Signed: ___________________________________________		Date: _______

Signed: ___________________________________________		Date: _______

Signed: ___________________________________________		Date: _______ 

Signed: ___________________________________________		Date: _______

In the case of partnerships or trustees, all partners/trustees must sign. In the case of a limited company, this application must be signed by a Director or Company Secretary or other authorised officer, in which case, we will require proof of authority. 

Please return this application form to: 
Private Sector Housing Standards
Po Box 700, Cambridge, CB1 0JH

In accordance with the Housing Act 2004 please note the following :

Section 238 - False or misleading information

(1)  A person commits an offence if —

(a)	he supplies any information to a local housing authority in connection with any of their functions under any of Parts 1 to 4 or this Part of the Act,

(b)	the information is false or misleading, and

(c)	he knows that it is false or misleading or is reckless as to whether it is false or misleading.

(2)  A person commits an offence if—

(a)	he supplies any information to another person which is false or misleading,

(b)	he knows that it is false or misleading or is reckless as to whether it is false or misleading, and

(c)	he knows that the information is to be used for the purpose of supplying information to a local housing authority in connection with any of their functions under any of Parts 1 to 4 or this Part of the Act.

(3)  A person who commits an offence under subsection (1) or (2) is liable on summary conviction to
      a fine not exceeding level 5 on the standard scale.

(4)  In this section “false or misleading” means false or misleading in any material respect.