2. What is the address of the tenancy? Address Line 1 *
Address Line 2
City *
County *
Select one
Antrim
Armagh
Carlow
Cavan
Clare
Cork
Derry/ Londonderry
Donegal
Down
Dublin
Fermanagh
Galway
Kerry
Kildare
Kilkenny
Laois
Leitrim
Limerick
Longford
Louth
Mayo
Meath
Monaghan
Offaly
Roscommon
Sligo
Tipperary
Tyrone
Waterford
Westmeath
Wexford
Wicklow
Eircode
3. Do Tenants share rented dwelling with the landlord? * Yes
No
The following situations are not within the jurisdiction of the RTB and a referral form for registration enforcement should not be submitted :
where a person shares facilities with the landlord, for example a bathroom/kitchen or
is renting a bedroom in a persons’ home, for example is living in a property as part of the rent a room scheme.
However, where a person is living in a self-contained unit within a property, for example an apartment, flat, converted garage, part of a house and has their own facilities (bathroom/kitchen), a referral form for registration enforcement can be submitted to the RTB
4. No. of bedrooms *
Select one
1
2
3
4
5
6
7
8
9
10
5. Is your landlord an Approved Housing Body? * Yes
No
6. Landlord Name (if known)
7. Agent Name (if known)
9. Tenancy Commencement Date
10. Should this matter proceed to court, are you willing to be a witness? * Yes
No
Please provide your name and contact details (these details will not be disclosed unless you have opted to be a witness in Court): Name
Address
Email
Phone
11. Are you a Member of the Public? * Yes
No
If no, please provide details e.g. public representative, member of An Garda Siochana, Local Authority, State Agency, Government Department
12. Are/were you a tenant of the dwelling?, if YES please indicate whether current/former tenant? * Current
Former
13. If you are a former tenant please provide the date your tenancy ended
14. If you are/were a tenant please provide copies of any documents / agreements which confirm your tenancy of the rented dwelling (if available)
15. Please provide any other relevant information which may relate to this matter:
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