Name:_Natalia Baizan________

Building:34 Flat:7 Room:E

Instructions:
etc.

1. Place an X in the second column if you accept the item status as is.
2. Note any current damages to the item. Look for holes, tears, stains,

3. If you think an item is not up to par please make a note of this

beside the corresponding item and leave the second column blank then return
this form.

Item
Bed

X if OK

Mattress
Desk

Carpets

Notes / Current Damages

none, brought/bought my own
none, brought/bought my own

brought
my own

wax stains on desk surface

lots of mud/dirt stains. did deep clean/shampoo but not

x
all came out

Window

Wardrobe / Clothes
rack

Shelves

Walls

Door, lock and

closer

Light working

Sockets working

Radiator working

bought one

This sheet to be completed within 7 days of the Date of Entry or receipt of said sheet,
whichever is later. Please print and return through the letterbox to flat 28/6, or print
name at the signature line below and return via email to eshc.finance@gmail.com. Doing
so will be considered equivalent to signing. If you fail to report problems then you may be
held liable for damages and missing items come the end of your tenancy, and lose your
deposit.

Signed:__Natalia Baizan_________________

Date:__18/9/2016