Satellite Application Webform - Cunninghame Housing Association

Satellite Application & Disclaimer Form

Tenants Name *

First

Last

Tenant's Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Contact Phone Number

Email *

Please tick which of the following you wish to install:

TV Aerial
Satellite Dish
Antennae

Confirm where the TV aerial will be sited (include a diagram of proposed location)

Confirm what type of antennae will be installed and where is will be sited (include a diagram of proposed location)

Details of the Company carrying out the installation:

Company Name

Company Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Company Contact Person's Name

Company Contact Person's Phone Number

Insurance Cover

Do you have the appropriate risk insurance cover in respect to public liability and home insurance covering the installation

Yes
No
Not Sure

Insurance Company Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

I/we understand that I/we cannot proceed with installing the TV aerial, Satellite dish or antennae until written permission is received from Cunninghame Housing Association Ltd. I/we understand that if I/we install prior to receiving written permission Cunninghame Housing Association will request that I/we remove the installation.

Tenant Signature *

By typing your name here you are digitally signing this form

Todays Date