1. The tenant(s) details. Names of each tenant (every tenant on a joint tenancy) and the address of the premises.
2. Details of the landlord. Name, contact address, phone and email. The form notes that phone and email are recommended but optional, and that giving an email address means the tenant and the tribunal may use it to serve documents on you.
3. Details of the agent, if you use one. Name, contact address, phone and email.
4. The rent. Current rent and how often it is paid; the date the tenancy started; the date of the most recent increase, if any; the date of the first increase after 11 February 2003, if any; the proposed new rent and its frequency; the date the new rent starts; and, for any charges included in the rent (council tax, water, fuel, communication services, fixed service charges), the existing and proposed amounts. The form's Note A sets out the dates the new rent can start on, and Note B covers the charges.
5. Signature. The landlord or the landlord's agent signs and dates it, and prints their name. For joint landlords, each signs in the additional signatures box, or they agree for one to sign for all.
Section 5 of the form, headed "What you (the tenant) should do next", is information for the tenant and is not filled in.