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Temporary accommodation move-out form

Fields marked * are required.

Property and occupiers

Leaving date and items returned

We confirm that we have moved out of the Property on:

Council tax and utility bills

We confirm that we stopped living at the Property on the date and time above.

We give permission for the Provider to send this form, our leaving date, final meter readings and our forwarding contact details to the Council and utility suppliers.

We will tell any utility company where an account is in our name that we have moved out. We will pay charges that we are legally or contractually responsible for up to the leaving date.

This form records our leaving date. The Council and utility suppliers decide responsibility for council tax and utility charges under the law and the relevant account or licence terms.

Meter readings

UtilitySupplierAccount name / number Final readingMeter numberMeter location
No readings added yet.

Forwarding contact details

Items left behind

We understand that we should remove all our belongings when we leave.

If any belongings are left behind, the Provider may store them and will contact us using the forwarding details above. The Provider may charge reasonable storage and removal costs where legally permitted.

Any belongings left behind will be dealt with only after any required legal notice and reasonable collection period. They may then be sold, donated or disposed of in accordance with applicable law.

Signatures

Occupier 1 *

Name: —

Date and time: —

Signed for Millwood Kane Limited *

Date and time: —

Witness

Date and time: —

Millwood Kane move-out form v1.2.