The Derby Accredited Property Scheme
Application for Renewal of Property Accreditation
Further copies of the Derby Accredited Property Scheme Application Forms can be downloaded from
www.derby.gov.uk/accreditation or are available from the Accreditation Office, Environment and Regulatory
Services, Derby City Council, Council House, Corporation Street, Derby DE1 2FS. Telephone: 01332
640764. Email: property.accreditation@derby.gov.uk
Please fill in this form in black or blue ink only. Write clearly within the boxes provided, and tick boxes  as
appropriate. If you do not complete all the relevant sections accurately and in full, the processing of the
application may be delayed.
Section 1 - Property Details
1.1 Address of property:
Postcode:
I wish this property to have its accreditation renewed for:
Number of households ………
Number of individuals ………
Please tick if the tenants are students
Examples: A property let to 4 students who are unrelated would contain 4 households, 4 individuals.
A property let to a family of 2 parents and 3 children would contain 1 household, 5 individuals.
The person who wishes to be the main point of contact should complete one of the following statements:
- I am the owner and I manage the property myself
- I am the owner but use a Managing Agent called ………………………………………………………
- I am a Managing Agent for the owner whose name is …………………………………………………
Section 2 – Details for the Main Point of Contact
Title:
Surname:
Date of Birth – Date, Month, Year
First names:
Home telephone number:
Residential address:
Mobile telephone number:
Email address:
Postcode:
If trading under a business name, trading as:
Office telephone number:
Business address – if different from above:
Mobile telephone number:
Email address:
Postcode:
I declare that the information given on this form is, and the declarations ticked overleaf are, to the
best of my knowledge and belief, true and correct. I also understand that any misrepresentation by
me may lead to the withdrawal of my membership from the Accreditation Scheme.
Owner / Landlord
Manager /
Managing Agent
Name – Please print
Signature:
Date:
Name – Please print
Signature:
Date:
Section 3 – Declarations. Please read each declaration and tick to state that you agree.
Tenancy Agreement
 I use the same tenancy agreement as last year, a copy of which was sent with the initial application.
or  I now use a different tenancy agreement and attach a sample copy.
The Tenancy Deposit Protection Scheme I am still registered with is:
The Deposit Protection Service
The Dispute Service Ltd
mydeposits.co.uk
I do not take a deposit
Alterations
Have you made any alterations to the property since its original Accreditation – added any rooms?
Yes
No
If yes, does this increase the number of occupants since the original Accreditation?
Yes
No
By how many? ………
Gas Safety
Is there a gas supply to the property?
Yes
No
If yes, I attach a copy of a current gas safety certificate from a Gas Safe Registered plumber which covers
all gas appliances in that property.
Electrical Safety
 I sent a copy of the Periodic Inspection Report for this property with my initial application, and it is
stated to be satisfactory and valid until _____ / _____ / 20 ____ .
or  My previous Periodic Inspection Report for this property has expired and so I attach a copy of a
current Periodic Inspection Report from a Part P compliant contractor, stating that the whole
property’s electrical installation is in a satisfactory condition.
Furniture Safety
 I hereby confirm that, to the best of my knowledge, the furniture supplied in the property or properties
under the terms of the tenancy agreements pertaining to it, to which this accreditation application applies,
meets the Furniture and Furnishings (Fire Safety) Regulations 1998 (as amended in 1989 and 1993).
or  I do not provide furniture.
Energy Performance Certificates
Where applicable I have provided an Energy Performance Certificate.
Fire Safety
Where appropriate, I attach current Fire Alarm test Certificates.
Where appropriate, I attach Emergency Lighting System test certificates.
List of Accredited Properties
 I agree to having my landlord contact details and the details of my Accredited Property/Properties being
included on Derby City Council’s list of Accredited properties which will be made available to the public.
 I commit to inform Derby City Council when available properties have been let, or when properties
become available again.
 I agree to inform Derby City Council of any change of ownership or management of the accredited property.
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page 29 of the Scheme Document.
For further information, please see Appendix H on page 29 of the Scheme Document.
Fit and Proper Person declaration
The declaration I made on initial application for accreditation regarding unspent convictions or offences has
not changed.
Planning / Building consent, if applicable
I have consulted the appropriate local authority planning officer or building control officer regarding any
requirements for planning or building consent.
Main Declaration
 I declare that I have read and understood Derby City Council’s Accredited Property Scheme Standards
for membership of the Accreditation Scheme for Private Rented Property.
 All Accredited properties under my ownership/management, which are let to tenants whilst I hold
membership of the Accreditation Scheme, will meet the Scheme Standards.
 I further declare that my conduct will be in accord with the Scheme Management Standards and that I
will recognise the authority of a Scheme Management Committee and ultimately the Independent
Review Panel in the administration of the Scheme Standards.
 I understand that any documentation supplied with this application may be checked for compliance with
the appropriate bodies.