N11R - Defence form (rented residential premises)

1 Defence form (rented residential premises) Name of courtClaim of ClaimantName of DefendantDate of hearingPersonal give your:Title Mr Mrs Miss Ms OtherFirst name(s) in fullLast nameDate of birthDDMMYYYYA ddress (if different from the address on the claim form )PostcodeDisputing the you agree with what is said about the premises andthe tenancy agreement? Yes NoIf No, set out your reasons below:Did you receive the notice from the claimant referred to at paragraph 6 of the particulars of claim? Yes Yes, when:N11R Defence form (rented residential premises) ( ) Crown copyright you agree that there are arrears of rent as stated inthe particulars of claim?

2 Yes NoIf No, state how much the arrears are: the particulars of claim give any reasons forpossession other than rent arrears, do you agree withwhat is said? Yes NoIf No, give details you have a money or other claim (a counterclaim)against your landlord? Yes NoIf Yes, give you paid any money to your landlord since theclaim was issued? Yes NoIf Yes, state how much you have paid and when: you come to any agreement with your landlordabout repaying the arrears since the claim was issued?I have agreed to pay each (week)(month) Yes you have not reached an agreement with yourlandlord, do you want the court to consider allowing youto pay the arrears by instalments?

3 Yes much can you afford to pay in addition to thecurrent rent? per (week)(month)About yourself State you receiving Income Support? Yes you applied for Income Support? Yes NoIf Yes, when did you apply? you receiving housing benefit? Yes NoIf Yes, how much are you receiving? per (week)(month) you applied for housing benefit? Yes NoIf Yes, when did you apply? the housing benefit paidto you to your landlordDependants (people you look after financially) you any dependant children? Yes NoIf Yes, give the number in each age group below:under 11 11-15 16-17 18 and overOther details of any other dependants for whom you arefinancially responsible:Other details of any other people living at the premisesfor whom you are not financially responsible:Money you receiveWeekly take-home pay or income if self-employedincluding overtime, commission, bonuses Job Seekers allowance pension Child benefit Other benefits and allowances Others living in my home give me I am paid maintenance for myself (or children) of Other income Total income accounts and savingsDo you have a current bank or building society account?

4 Yes NoIf Yes, is it in credit? If so, by how much? overdrawn? If so, by how much? you have a savings or deposit account? Yes NoIf Yes, what is the balance? Money you pay you have to pay any court orders or fines?Court Claim/Case number Balance owing InstalmentspaidTotal Instalments paid per details if you are in arrears with any of the courtpayments or you have any loan or credit debts? Yes NoLoan/credit from Balance owing Instalments paidTotal Instalments per details if you are in arrears with any loan / creditrepayments:Regular expenses(Do not include any payments made by other members of the household out of their own income) regular expenses do you have?

5 (List below)Weekly MonthlyCouncil tax Gas Electricity Water charges TV rental & licence Telephone Credit repayments Mail order Housekeeping, food, school mealsTravelling expenses Clothing Maintenance payments Other Total expenses Priority section is for arrears only. Do notinclude regular expenses listed at Question MonthlyCouncil tax arrears Water charges arrears Gas account Electricity account Maintenance arrears Others (give details below) an order for possession were to be made, would youhave somewhere else to live? Yes NoIf Yes, say when you would be able to move details of any events or circumstances which have led to your being in arrears of rent (forexample divorce, separation, redundancy, bereavement, illness, bankruptcy) or any other particularcircumstances affecting your case.

6 If there are any reasons why the date any possession ordertakes effect should be delayed, give them here. If you believe you would suffer exceptional hardshipby being ordered to leave the property immediately, say need only answer question 30 if the claim form includes a claim for demotion or suspension of right to you agree with what is said about your conduct oruse of the property? Yes NoIf No, set out your reasons below:Statement of TruthI understand that proceedings for contempt of court may be brought against anyone who makes, or causes to be made, a false statement in a document verified by a statement of truth without an honest belief in its truth. I believe that the facts stated in this Defence form are Defendant believes that the facts stated in this Defence form are true.

7 I am authorised by the defendant to sign this statement. Signature DefendantLitigation friend (where defendant is a child or a patient)Defendant s legal representative (as defined by CPR (1))DateDayMonthYearFull nameName of defendant s legal representative s firmIf signing on behalf of firm or company give position or office hel