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* 1. Your name:

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* 2. Your membership number or postcode:

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* 3. Your landlord:

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* 4. Your landlord’s agent’s name:

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* 5. Your landlord's agents firm (if any):

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* 6. Your rating of your landlord’s agent's 'Professionalism' (1 Star Poor - 5 Stars Excellent)

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* 7. Your rating of your landlord’s agent's 'Timeliness' (1 Star Poor - 5 Stars Excellent)

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* 8. Your rating of your landlord’s agent's 'Promoting good landlord tenant relationships' (1 Star Poor - 5 Stars Excellent)

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* 9. Your rating of your landlord’s agent's 'Overall rating' (1 Star Poor - 5 Stars Excellent)

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* 10. Main issue (e.g. rent review, succession, consent for non agricultural activity, etc):

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* 11. Comments:

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