Prtb 1 Form – Fill Out and Use This PDF

3.Address of Rented Dwelling: (include unit number if property is let in 2 or more units)

Address:

4.Description of Rented Dwelling: (if the rented dwelling is part of a house or maisonette please tick ‘Part of House’ along with the type of house, e.g. detached house)

Whole of House		Detached House		Bedsit

9.Landlord - Name and Contact Details: (if more than 1 landlord involved in this tenancy please complete Part 5 of this Form, see also Note E)

First name:

Surname:

Address:

Telephone (optional):

Mobile Phone (optional):

10. PPSN of Landlord: (see Note F)

Reproduction of this form is permitted (only fully completed forms will be accepted)

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FORM PRTB1

11.Landlord's Letting Agent (if any) - Name and Contact Details: (if the premises is let through an agent)

Name:

Address:

Telephone (optional):

12. Agent PPSN or Company Reg.No:

13.Local Authority - Name of Area: (see Note G)

14.Tenant - Name and Contact Details: (if more than 1 tenant involved in this tenancy please complete Part 4 of this Form, see also Note H)

First name:

18.Sub-letting : If this tenancy is a sub-letting please tick:

Reproduction of this form is permitted (only fully completed forms will be accepted)

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FORM PRTB1

Part 4 - Details of Any Additional Tenants (minors not required)

23.Name and Contact Details of additional Tenants: (see Notes F, H, I and J)

First name:

Surname:

Telephone (optional):
PPSN:
Tenant Signature:	Date:

Part 5 - Details of Additional Landlords (if more than 1 Landlord)

24.Name and Contact Details of other Landlord(s) involved: (see Notes E, F and K)

First name:

Surname:

Address:

Telephone (optional):

Mobile Phone (optional):

PPSN:

Landlord Signature:		Date:

Reproduction of this form is permitted (only fully completed forms will be accepted)

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FORM PRTB1

Part 6 - Apartment Blocks/Complexes Only

(This part of the form should be completed if the dwelling concerned is an apartment in an apartment complex under the operation of a management company.)

25.Management Company - Name and Contact Details: (see Note L)

Name:

Address:

Telephone (optional):

26. Management Company Reg. No:

27.Management Agents (if any)- Name and Contact Details: (see Note L)

Name:

Address:

Telephone (optional):

28. Agent PPSN or Company Reg. No:

Part 7 Payment by Credit / Debit Card

If you wish to pay your registration fee by credit / debit card please complete the details below:

*Please ensure your address is the same as on your bank/credit card statement

Reproduction of this form is permitted (only fully completed forms will be accepted)

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FORM PRTB1

For Official Use Only

Checklist

Before sending this form to the PRTB, please check that:

the tenant(s) has(ve) provided their PPSN on the form;

the tenant(s) has(ve) signed and dated the form;

your own PPSN is on the form;

you have signed and dated the form;

you have completed all questions on the form; and

you have enclosed a cheque for the correct amount and made it payable to the PRTB or provided your credit/debit card details at Part 7.

Please note that an incomplete form will be returned to you.

Notes for Completion of Tenancy Registration Form PRTB1

In completing this form, use CAPITAL LETTERS. Write clearly and accurately within boxes. Do not join your writing.

AIf this is a new tenancy registration all parts of this form should be completed (apart from the Registration No. which will be issued to you on foot of this application). If this application relates to the updating of a tenancy currently registered with the Private Residential Tenancies Board (PRTB) please enter the Registration No. and complete only the sections to be updated.

BThe fees set out below are the current fees at the time of printing (July 2006). As fees could be subject to change in the future, you are advised to check the up-to-date fees payable at the time of registering the tenancy - the PRTB’s website, www.prtb.ie will be of assistance in this regard.

The fee payable is €70 per tenancy being registered on time i.e. within 1 month after the commencement of the tenancy or €300 for multiple tenancies in the one building being registered on time by the one landlord (please staple the multiple forms together).

Where, in respect of the same dwelling, a change of tenancy occurs within a 12 month

period a maximum of 2 registration fees apply. However, no fee applies in respect of a 3rd or subsequent registration of the same dwelling within that 12 months. No fee is payable for an update of details of a tenancy currently registered.

In all circumstances where the tenancy is being registered more than 1 month after the commencement of the tenancy, a fee of €140, per tenancy, is payable for these late registrations. There are no exceptions to this

Fees should be paid by cheque, postal order or money order and should be made payable to the PRTB. The cheque should be crossed. Alternatively you may make your payment by credit or debit card by completing your details in Part 7. Cash should not be sent in the post with the registration form.

CPlease use number of bed spaces rather than number of bedrooms in the premises. e.g. a double bed equals 2 spaces.

Reproduction of this form is permitted (only fully completed forms will be accepted)

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FORM PRTB1

DPlease give approximate floor area of the rental unit not the floor area of the full premises unless the full premises is the subject of this registration application. To convert from square feet to square metres the following values should be used:

-1 sq. foot = 0.0929 sq. metres

-1 sq. yard = 0.8361 sq. metres

EIf there is more than one landlord involved in the tenancy please use Part 5 of this form to identify each additional landlord. Please note that the address of the landlord will be used by the PRTB for corresponding with the landlord. If a different correspondence address is required, e.g. Agent's address, this should be specified under the address of the landlord.

FPPSN (also known as RSI number) is unique to each individual and is used to distinguish between individuals with similar names or addresses. The PPSN is usually identified on tax and welfare statements and P60s. If you do not have a PPSN number please contact your local Department of Social and Family Affairs (DSFA) office. Use of the PPSN is governed by law. The PPSN is not to be stored or used for any purpose other than for the registration of a tenancy. The PPSN Code of Practice is available from the DSFA and on their website (www.welfare.ie).

GPlease indicate in which local authority area the dwelling is located. The authorities are: City Councils - Cork, Dublin, Galway, Limerick, Waterford,

Borough Councils - Clonmel, Drogheda, Kilkenny, Sligo and Wexford.

County Councils - Dun Laoghaire - Rathdown, Fingal, South Dublin, Carlow, Cavan, Clare, Cork, Donegal, Galway, Kerry, Kildare, Kilkenny, Laois, Leitrim, Limerick, Longford, Louth, Mayo, Meath, Monaghan, Offaly, Roscommon, Sligo, Tipperary (NR), Tipperary (SR), Waterford, Westmeath, Wexford, Wicklow.

Town Councils - Arklow, Athlone, Athy, Ballina, Ballinasloe, Birr, Bray, Buncrana, Bundoran, Carlow, Carrickmacross, Carrick-on-Suir, Cashel, Castlebar, Castleblaney, Cavan, Clonakilty, Clones, Cobh, Dundalk, Dungarvan, Ennis, Enniscorthy, Fermoy, Kells, Killarney, Kilrush, Kinsale, Letterkenny, Listowel, Longford, Macroom, Mallow, Midleton, Monaghan, Naas, Navan, Nenagh, New Ross, Skibbereen, Templemore, Thurles, Tipperary, Tralee, Trim, Tullamore, Westport, Wicklow, Youghal.

HIf there is more than one tenant of the dwelling please use Part 4 of this form to identify each additional tenant.

IThe PPSN of the tenant(s) should be provided unless it cannot be ascertained by reasonable inquiry. If a tenant does not want the other tenants to see his/her PPSN, then the tenant should provide this to the landlord on a separate piece of paper.

JThe application form must be signed by the tenant or each of the tenants, as the case may be, of the dwelling concerned and bear the date on which it is signed by the tenant or tenants.

KThe application form must be signed by the landlord of the dwelling concerned or by his/ her authorised agent and dated when signed.

LIn the case of apartment blocks/complexes, the management company is responsible for the day-to-day management of the block/complex. In some instances, the management company engages a management agent to perform the functions of managing the properties on behalf of the management company.

Registration data collected by the Private Residential Tenancies Board (PRTB) will be used in accordance with the provisions of the Residential Tenancies Act 2004 and any other relevant legislation.

Reproduction of this form is permitted (only fully completed forms will be accepted)

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