1) How much is your weekly rent? (to the nearest hundred)

    2) How many rooms are affected by the disrepair?

    3) Which rooms are affected by the disrepair?

    4) What is the type of disrepair?

    5) When did you first report the disrepair to your landlord?

    6) How long has there been disrepair at the property? (to the nearest year)

    7) How severe is the disrepair? (5 being the highest)?

    8) Has your repair been rectified?

    9) Approximately, what is the replacement value of your personal belongings that have damaged by the disrepair?

    Who is your landlord?

    Please Upload images/Videos of any damage in your property that has not yet been fixed?