Appointment form

Which are you?*

Address of the site (where the work is taking place)*

Street Address

Street Address 2

Town/CityCounty

Post Code

The address of your property*

Street Address

Street Address 2

Town/CityCounty

Post Code

Full names of all owners of your property / company name (if owned by a company)*

Separate each name with a comma

Correspondence address / registered company address *

Street Address

Street Address 2

Town/CityCounty

Post Code

Contact details for you / your appointed representative*

*Where there is more than one owner or a corporate owner/organisation, please specify an appointed representative who will act on their behalf. All communication will be via this person.

Contact name*

First Name(s)Last Name(s)

Contact email*

(By providing an email address here, consent is given to receive any notices and/or any other relevant documents under the Party Wall Etc. Act 1996 to that email address.)

Contact phone number*

4/5 digitsRemaining digits

Please provide the full addresses of all adjoining neighbours you want us to serve notices upon (if not known, type 'Not known').*

Authority to act
Coburns Party Wall are hereby authorised to sign, issue, serve, send, receive and respond to all notices under the Party Wall etc. Act 1996 in relation to the works currently proposed at the building owner’s address.

Formal appointment under the Act
In the event of a dispute arising within the meaning of the Act Mr K. GREWAL is appointed as a surveyor in accordance with section 10(1) of the Act and he has authority to act as the agreed surveyor.
He is further authorised to make all requests and appointments under the Act that may be necessary and has authority to forgo any relevant notice period.

Building owner appointment
The building owner(s) hereby confirm acceptance of the fee proposal as per the quote email. If no quote was emailed, they confirm acceptance of the fees as stated in the document ‘PARTY WALL FEES AND GUIDANCE’ available on the Coburns website. They also confirm acceptance of the payment terms specified in the above document.
The building owner(s) hereby accepts responsibility for costs incurred in preparing and serving notice(s), site visit(s), recording any condition record(s) and making and serving any award(s), or other task(s) deemed necessary, in advance of any award being served.

Adjoining owner appointment
There is no expectation of costs for adjoining neighbours in the making of an award permitting works. However, where an adjoining owner acts unreasonably and/or wastes Coburns Party Wall’s time after being advised not to, costs may be incurred.
Costs for awards relating to disputes arising from previously awarded work are to be determined by the surveyor(s).

Signed Authorisation
This document is signed on behalf of the owner(s).

By signing it is confirmed that owner(s) is an owner within the meaning of the Act.
If signing on behalf of all of the owners or on behalf of an organisation or corporate body, the signatory confirms that they have the necessary authority.
I understand and accept that my electronic signature will be as valid as a handwritten signature and considered original to the extent allowed by applicable law.

Signature*

How did you hear about us?*

Building owner text

Consumer Disclosure Regarding Signing Documents Electronically, Conducting Business Electronically, and Receiving Electronic Documents, Notices and Disclosures

By utilizing an electronic signature service, you are agreeing that you have reviewed this disclosure and you consent to utilizing electronic signatures in lieu of using handwritten or non-digital signatures or paper, to conduct business using electronic communications, and to receive notices, signatures, and disclosures electronically. You are not required by law to consent to any of these things.

If you do not agree to utilize electronic signatures in lieu of using handwritten or non-digital signatures or paper, please email info@coburnspartywall.co.uk for an alternative.

Adjoining owner text

I am/represent the

Address for email notification

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code