Authority to Act in respect of Electricity Equipment

Authority to Act in respect of Electricity Equipment
Case Reference*
You can usually find this at the top of any letter we have sent to you. If you're unsure, enter six zeros (e.g. 000000).
Subject Property Address*

Address Line 1

Address Line 2

Town/CityState / Province

Postcode

Owner Information
Owner 1 - Title*
Owner 1 - Name*

First NameLast Name
Owner 1 - Mobile Number*
e.g. 07456 123789
Owner 1 - Email*
example@example.com
Is there a second owner of the property?*

YesNo
Owner 2 - Title*
Owner 2 - Name*

First NameLast Name
Owner 2 - Mobile Number*
e.g. 07456 123789
Owner 2 - Email*
example@example.com

Property Info
Current estimate of property value*
If you're unsure, please enter your best guess.
Date property purchased

DayMonthYear
If you're unsure of the exact date, choose the first day of the month and year.
Do you currently receive a wayleave payment?

YesNo

Terms of Engagement
1. The Owner(s) instruct and appoint Thomson Broadbent Ltd ("the Company") as sole and exclusive agent for the full duration of the claim process to negotiate a new wayleave or easement (servitude in Scotland) agreement in respect of the presence of overhead and underground power lines, poles, pylons, fibre optic cables, stays, transformers and/or other electrical equipment which is currently situated on my/our property.
2. The Owner(s) acknowledge and understand that the company will use and store their data as stated in the Privacy Policy Notice.
3. The Owner(s) acknowledge, understand, and accept the Company's Terms of Business (Wayleave and Easement Consents) version 2.5 which they have read and understand form part of the contract between us.
4. The Owner(s) agree to pay to the Company a Contingent Fee as set out in the Terms of Business, calculated as a percentage of the consideration that the Company Negotiates for you, as follows:
4.1. 20% plus VAT for High Voltage cases.

4.2. No Contingent Fee for Low Voltage Only cases.

In signing below the Owner(s) confirm they have read the terms of engagement (above) and, on behalf of all owners, now wish to appoint Thomson Broadbent.
Signed*

Clear
Date*

DayMonthYear
Date
Full Name (of person completing this form)*
Should be Empty: