If you are a human and are seeing this field, please leave it blank. Page 1 of 2 We hereby authorise you to take control under the Taking Control of Goods Regulations 2013 the goods & effects in tenure & occupation of Name of tenant Up to Business hours Trading name For the sum of Type of premises Due on Being situated at Being arrears of rent due to the landlord And to proceed therein for the recovery of the said Rents and Costs of Recovery as the law directs under The Taking Control of Goods Regulations 2013 and S4 para1 of The Taking Control of Goods (Fees) Regulations 2014 pursuant to Schedule 12 of The Tribunals Courts and Enforcement Act 2007 and for so doing, this shall be your sufficient authority and indemnification against all Actions at Law, as well as against all costs, charges or expenses which you may incur or be liable to pay by reason of your executing this instruction, and hereby undertake not to hold you accountable for any goods forcibly or clandestinely removed. Page 2 of 2 Name of authority Dated this Name Telephone Address Payment details for monies recovered Sort code Account number Your reference Confirmation By entering your details in the Authorisation Section you confirm that this constitutes an Electronic Signature. A copy of this form will be sent to the email address entered below.