Application for someone to act as an appointee

Latest revision date: August 2020
Revision due date: August 2021


Who is this form for?

Please use this form if you want someone to act on your behalf.

What is an Appointee?

An appointee is a person who has the authority to receive information, make decision and act on behalf of a tenant(s). This is an agreement with Berneslai Homes, the tenant(s) and the third party who is acting as an appointee.

What does this mean to you?

As a tenant of Berneslai Homes who has an appointee in place, you will no longer receive any correspondence from us. The appointee will also have permission to make decision on your behalf in relation to your tenancy but they do not have the authority to end your tenancy. If you contact us, we will still speak to you, but if we need to contact you we will do this through your appointee.

Protecting your personal data

By completing this form you acknowledge that we will follow our responsibilities under data protection legislation. We will store the information securely, share it with partners and other statutory agencies where we have the right under law to do this, use it only for the purpose it was provided and process it as set out in our privacy policy. For more information please see our privacy policy on our website
  • About you (the tenant)
  • Title *

  • First Name *

  • Last Name *

  • Address *

  • Phone Number *

  • Email Address

  • About the person you want to act as an appointee
  • Title *

  • First Name *

  • Last Name *

  • Address *

  • Phone number *

  • Email Address

  • Relationship to you *

  • The reason you want them to act as an appointee *

  • Please tell us who

  • Agreement of the tenant
  • By completing this form you acknowledge that we will follow our responsibilities under data protection legislation. We will store the information securely, share it with partners and other statutory agencies where we have the right under law to do this, use it only for the purpose it was provided and process it as set out in our privacy policy. For more information please see our privacy policy on our website
  • Your name *

  • By ticking the box below, I/we agree that the person named in this application can act as an appointee on my/our behalf in relation to this tenancy. I/we understand that they will receive all information from Berneslai Homes about my tenancy. I/we understand that is my/our responsibility to tell you of any change in circumstances or if I/we want the appointee to stop acting on my/our behalf.
  • Confirm

  • Agreement of the appointee
  • Your name *

  • I declare that the information I have given on this form is correct and complete. 

    I understand that if you later find that I have deliberately supplied false information or omitted to supply information, you may take action.

    I understand that if I have not completed this form fully it may result in a delay in us acting on your request.

    I understand you may share my information with other agencies to detect and prevent fraud.

    I agree to act as an appointee for the tenant/s named in this application in matters relating to their tenancy.

    I understand that I will receive all information from Berneslai Homes relating to their tenancy and I agree to share that information with the tenant/s.

    I agree to act in the interest of the tenant/s at all times.

    I agree to inform Berneslai Homes of any changes to my circumstances.

    I understand that it is my responsibility to tell the tenant/s and Berneslai Homes if I want to stop acting as an appointee.
  • *

    Confirm