Warrant to Distrain Form

I HEREBY AUTHORISE AND EMPOWER YOU to seize and distrain in the manner allowed by law, the goods and chattels of :

(tenant)

for the sum of:

pounds

being rent due up to the:

day of

month

year

for

(demised premises).

And to proceed therein for the recovery of the said rents and costs of distress as the law directs: And for so doing, this shall be sufficient Warrant, Authority and Indemnification against all Actions at Law as well as against all costs, charges or expenses which you may incur or be liable to pay by reason of your executing this Warrant, and hereby undertake not to hold you accountable for any goods forcibly or clandestinely removed.

Dated this:

day of

month

year.

Enter your name to sign this form:

Please TICK type of premises:

Shop

Office

Factory

Warehouse

Club

Other

Other relevant information (shop/office address, club landlord etc.):

Phone Number:

Email Address:

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This form will be emailed to you as will need to be printed and signed before sending to Madagans.

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