Private and Confidential
HIA1 (v3)
Please return this form to:Private Sector Housing Team
Knowsthorpe Gate
Cross Green
Leeds
LS9 0NP
Email: HIA@leeds.gov.uk
Property Level Resilience Grant Scheme
Leeds
Application Form
PLEASE ANSWER QUESTIONS IN CAPITAL LETTERS
OR CIRCLE THE RELEVANT ANSWERS.
1. Address Details
Address of property at which the works are to be carried out:
Address for correspondence (if different):
Postcode:
Home Telephone Number:
Work/Mobile Telephone Number:
E-mail Address:
Postcode:
Home Telephone Number:
Work/Mobile Telephone Number:
E-mail Address:
2. Ownership Details
Full name(s) of person(s) having ownership interest in the above said property or a lease with repairing obligations.
Title
Forename
Surname
If you have a lease with repairing obligations you will need the consent of the freeholder. Please attach a
copy of the lease agreement and freeholder consent.
3. Flood Details
Date Property was flooded
_______________________________________
Cause of Flooding (Please tick)
Overwhelmed river
Blocked drainage
Extreme rainfall
Surface run off
Other (please specify) _______________________________________
Name of Insurance Company
_______________________________________
Your Insurance Company should provide you with a report to improve the resilience of your home in the event of
future funding. This survey has been carried out to identify the most appropriate flood resilience measures, please
provide a copy with this application. Alternatively a report by an independent specialist surveyor can be provided. The
cost of such a report will be covered by the grant.
If you have not had a survey, please provide a copy of a tailored report from the National Flood Forum. Tailored reports are
easy to obtain from www.nationalfloodforum.org.uk/property-level-protection-community-tool.
4. Grant details
Please note that the maximum grant that can be applied for is £5,000 (including VAT). Any costs incurred above
£5,000 will need to be met from your own funds.
You are not eligible to apply for a Property Level Resilience Grant if you have already received other sources
of public or insurance funding to establish the same resilience and / or resistance measures applied for
(such as from a Property Level Protection Scheme).
Have you received any alternative funding (such as previous grant funding or insurance claim payment
for any of the equipment you are applying for grant funding for?
YES / NO
If yes, please specify and state why you are also seeking a Property Level Resilience Grant.
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Are you applying for resilience / resistance measures that you will install prior to 30 September 2016. YES / NO
Are you applying for resilience / resistance measures that you have already purchased and installed
following the flooding (retrospective application).
YES / NO
For retrospective applications please provide copy invoices for the work carried out.
Payment will be made to successful applicants by electronic transfer to your nominated bank account and an email /
letter will be issued to confirm payment. Please complete the details below so that payment can be made.
Payee name
…………………………………………………………………………
Name of bank …………………………………………………………………………
Sort Code
…………………………………………………………………………
Account Number …………………………………………………………………………
06/2011
4. Flood Measures
Below is a list of recognised flood resilience measures. Please indicate
which of the available measures you intend to or have installed (if a
retrospective application), and cost.
Please note that the maximum grant that can be applied for is £5,000.
Resistance Measures
Demountable Door Guards
Demountable Window Guards
Airbrick Cover
Sewage Bung
Toilet Pan Seal
Sump Pump
Re-pointing external walls with water resistant
mortar
Waterproof external walls
Automatic Door Guards
Permanent flood door
Automatic Window Guards
Self-closing airbrick
Non-return valves 110 mm soil waste pipe
NRV 40 mm utility waste pipe
NRV 12 mm overflow pipe
Garage/ Driveway Barrier
Professional advice on flood resistance/ resilience
Replace sand-cement screeds on solid concrete
slabs (with dense screed)
Replace chipboard flooring with treated timber
floorboards
Replace floor including joists with treated timber to
make water resilient
Replace timber floor with solid concrete
Raise floor above most likely flood level
Replace mineral insulation within walls with closed
cell insulation
Replace gypsum plaster with water resistant
material, such as lime
Install chemical damp-proof course below joist
level
Replace doors, windows, frames with waterresistant alternatives
Indicate works and
estimate cost(based on
the flood report/
estimates from websites)
Indicate works and
estimate cost(based on
the flood report/
estimates from websites)
Resistance Measures
Sceptic tank resistance or resilience measures
(such as isolation valves, venting above flood level
etc)
Mount boilers on wall
Move washing machine to first floor
Replace ovens with raised, build-under type
Move electrics well above likely flood level
Move service meters well above likely flood level
Replace chipboard kitchen/ bathroom units with
plastic units
Flood Risk Report
Other (please state, attach additional information if needed):
Survey cost
£
Total Cost of Resilience/ Resistance
Measures implementing including
Future costs
£
Total Amount of Grant Applying For if
different (maximum £5,000)
£
A copy of the completed works invoice must be forwarded to this office by 30 September 2016. Please note
that at some future stage the Council may visit the premises to ensure the resilience and / or resistance
measures have been installed in line with the requirements of the grant.
06/2011
6 Terms
PLEASE READ THROUGH THE TERMS AND DECLARATION CAREFULLY BEFORE SIGNING AND SUBMITTING YOUR
APPLICATION. THE FOLLOWING SETS OUT THE TERMS BY WHICH THE GRANT OFFER WILL BE MADE IF YOUR
APPLICATION IS SUCCESSFUL.
I / we agree to purchase and install the resilience / resistance measures that you have identified on the attached
report.
The measures you have chosen to fit to your property have been selected entirely at your own risk. Should the
property flood again in the future, the Council maintains no liability for the selection or installation of the measures you
have chosen.
I / we agree to store the Measures securely and protect them from damage.
I / we agree to maintain the Measures in accordance with the manufacturer’s instructions.
I / we agree to sign up to the Environment Agency’s Flood Warning Scheme.
I / we agree to use the Measures in accordance with the manufacturer’s instructions.
I / we agree to allow the Council access to the Property at all reasonable times for the purposes of inspection of the
Measures.
I / we agree that if the property is sold in the future, the Measures will remain with the property and pass to the new
owner.
The details of your name and address, details of resilience and / or resistance measures installed and the outcome of
any inspection visits will be shared with the Department for Environment, Food and Rural Affairs (Defra). The Council
will not (for any reason) share any of the information you have submitted with a third party.
The Council or Defra may contact you in the future for the purposes of research, to identify if the Property Level
Resilience Grant and the measures you selected have been of benefit to you or to inform you of any future flood
response schemes.
The Council shall not be liable to the Property Owner or persons with a lease with repairing obligations for any action,
claim, demand, cost or expense incurred in respect of any loss or damage, including for any negligence, breach of
contract, property damage or personal injury (including death) including any consequential or indirect loss, which
arises out of or in connection with the installation or use of the resilience and / or resistance measures.
The Council shall not be responsible for providing flood warnings or for ensuring that any party does so.
The Council shall not be responsible for removing any fixtures associated with the Measures if or when the
Property Owner no longer requires them.
Ownership of the Measures shall vest in the Property Owner and the Council shall not be responsible for the repair or
replacement of damaged or lost flood protection and resilience measures nor for the provision of any future
measures.
7. Declaration
I / we agree to the terms set out in this Application.
I / we confirm we are the lawful owner(s) of / hold a lease with repairing rights for the property detailed in Section 1 of
the application form
Public funds must be protected and so the information you have provided on this form may be used to prevent and
detect fraud. Should it be found that you have not used the grant funds to purchase and install the Measures identified
in the attached Report, or that upon inspection the Measures are not found to be in place / available on site, or in an
adequate state of maintenance, you risk prosecution and recovery of all grant payments.
To the best of my / our knowledge the information in this form and all other information given in support of this
application is correct. I confirm that I / we understand the purpose of this form and the reasons for the collection of
my / our personal data (to the extent that this application form contains information which is personal data for the
purposes of the Data Protection Act 1998)and that I agree to my / our personal data being used as stated.
If any information changes I will inform Leeds City Council immediately.
Name ………………………………………… Signature …………………………………… Date …………………………
Name ………………………………………… Signature …………………………………… Date …………………………
Name ………………………………………… Signature …………………………………… Date …………………………
Please include the following with your application.
A copy of the survey carried out by your Insurance Company detailing works required, or
a survey by an independent specialist surveyor.
FOR OFFICE USE ONLY
I ...................................................................................... have completed this form on behalf of the applicant and have
read all the details over to him/her before asking him/her to sign the declaration.
Signature: ....................................................................................................... Date: ........../........../..........
06/2011