Housing Register Application Form - Shepway District Council

Housing RegisterApplication FormApplication NumberDate received at Housing OptionsSurnameAddressPlease read the guidance notes below carefully before you complete this form.The information you provide will be treated confidentially for housing purposes only. Please fill in all parts ofthis form and make sure that you sign and return the form along with the supporting evidence that we ask for.Filling in this formPlease read this form carefully before you fill it in. IfEnglish is not your first language please ask for thisform to be translated. When you have completed theform please return the form to Housing Options Teamat Shepway District Council, Civic Centre, Castle HillAvenue, Folkestone, Kent CT20 2QY.What happens next?We need to make sure you qualify to be on ourhousing register, we may need to visit you at home.A home visit may be carried out to confirm yourliving arrangements. We will do our best to make theappointment at a convenient time for you.We will also check:• If you have registered with us for housing before• If you owe rent from another tenancy• If you have been evicted in the pastWe will then assess your application on a pointsscheme based on your current housing situation alongwith any medical/health issues, special needs orother relevant circumstances that are affected by yourpresent accommodation and placed in priority orderon the Shepway Housing Register.Changes in your circumstancesIf there is any change to your living arrangement,for example, you move home, or have a child, youshould let us know as soon as possible to make sureyour application is correctly pointed. When we makeyou an offer of housing we carry out checks to makecertain that your circumstances have not changedbefore you sign a tenancy.We need all this information because we have alegal duty to make sure your details are correct.This helps us to give priority to those in most need.

Supporting Evidence - Please make sure you read this page carefully.Please ensure that all supporting evidence, if applicable, is attached with your application form. If we do notreceive the supporting evidence, your application will not be processed and will be returned to you.ADULTSIdentityPlease provide 1 form of identity for each adult (over 18)Photo Identification – Passport, Driving LicenceBirth Certificate – Either British or non-British (non-British must be accompanied by a copy ofsettlement/immigration document), orWorker Registration documents / If self employed you must provide Inland Revenue tax return detailsResidence PermitCurrent Passport and Immigration DocumentsNon-EU passports must show immigration visa stampResidencePlease provide 2 different proofs from the following list of your current address for each adult (over 18).Full driving licencePension DetailsConfirmation of benefits from DWPConfirmation from employerRent Book/CardTenancy AgreementRecent Bank StatementRecent bill for telephone / mobileRecent bill for Council TaxRecent bill for Gas/Electricity/Water SupplyElectoral Register EntryPayslip showing name and current addressCollege /University details showing name and current addressCHILDRENIdentityFor each child under 18 years, please provide eitherBritish full birth certificateBritish short birth certificate – you must also provide child benefit details giving child/children name(s)Non-British birth certificate must be accompanied by a copy of settlement/immigration document andChild Benefit details – giving child/children name(s), Child Tax Credit – details giving child/childrenname(s)PregnancyPlease provide one of the following showing Expected Due Date (EDD)Anti-natal card/book/scan reportCertificate of Confinement/MATBIGP confirmationHospital BookPage 2

1 Your DetailsSurnameFirst nameMr Mrs Miss Ms Male Female TransgenderDate of birthTelephone numberEmail addressYour current address (you will have to provide proof of this)Post CodeWhat date did you move hereCorrespondence address (if different from above)Please tell us why you would like us to write to you at this addressPost CodeAddresses in the last five years (if different from your current address)Address Dates From Dates To Landlord Name,Address & Contact No.Reason for leavingHow long have you lived in Shepway?Do you have a permanent job in Shepway?YesNoHave you previously lived in ShepwayYesNoIf YES, tell us the dates whenyou lived in Shepway?FromDAYMONTHYEARToDAYMONTHYEARPage 3

2 About your household Joint Applicant DetailsSurnameFirst nameMr Mrs Miss Ms Male Female TransgenderDate of birthTelephone numberEmail addressRelationship to applicantJoint applicant current addressPost CodeJoint applicant addresses in the last five years (if different from their current address)Address Dates From Dates To Landlord Name,Address & Contact No.Reason for leavingHow long have they lived in Shepway?Do they have a permanent job in Shepway?YesNoHave they previously lived in ShepwayYesNoIf YES, tell us the dates whenthey lived in Shepway?FromDAYMONTHYEARToDAYMONTHYEARPlease list all other members of your household that will be housed with you.Full nameMale orFemale(M or F)Date of BirthRelationshipto youIs thispersonliving withyou now?(Yes or No)Page 4

Is anyone expecting a baby? If yes, please tell us who.Surname First Name Date baby is duePlease tell us when the baby is born by completing a birth of baby formAre you or anyone on your application employed by, or a member of anRSL (housing association) or Shepway District Council?YesNoAre you or anyone on your application related to an employee or member of anRSL (housing association) or Shepway District Council? Yes NoIf YES, give name position and relationship to youSex Offenders ActHave you or anyone on your application been convicted under theSex Offenders Act 1997 and placed on the Sex Offenders Register?If YES, please give detailsYesNoCriminal ActHave you or anyone on your application been convicted of a criminal act?If YES, please give detailsYesNoImmigration ControlThe law says that if you do not usually live in the UK, or you are subject to immigration control, you can only apply forhousing in certain circumstances.Please answer all the questions below so that we can decide whether you can apply for housing.Do you or any member of your household have any restriction on your/their stay in the UK?If YES, please give details including names, dates and outcome.YesNoAre you, or any member of your household subject to immigration control?If YES, please give details including names, dates and outcomeYesNoPage 5

3 About where you are living nowTick [✓] one answer onlyI rent from a private landlordI live with familyI am staying with friendsI am sleeping roughI am sofa surfingI am in lodgingsI rent from the councilI rent from an RSL (housing association)I own/am buying my homeI am in supported housingI am in a refugeI am in a hostelI am in a Housing Association Leased PropertyI am in a caravan/mobile homeI rent with my job (tied accommodation)I am in a hospital/nursing homeI am in a Bed & BreakfastI am in an institution*, e.g. prison*Give expected release date:Give the name and address of your landlordPostcode:Telephone number (if known):Landlord’s email address:What type of property is it?HouseBungalowFlatBedsitJust a roomCaravan/Mobile HomeMaisonetteHow many bedrooms are there in the property?How many bedrooms do you and the people listed on your application have sole use of?Do you have a separate dining room? Yes NoDo you or anyone listed on your application sleep in any other rooms(for example living room, lounge)? Yes NoIf YES, who?Which room(s)Page 6

Flats, Maisonettes and Studio FlatsYou must complete this section if you are living in a flat, maisonette or studio flatDo you have stairs to climb to get to your home? Yes NoWhich floor is the flat, maisonette or bedsit on? Basement Ground 1st2ndAboveIs there a lift? Yes NoFacilities in the propertyTell us about the following facilities in your propertyTick [✓] the boxes that apply to youHave soleuse ofShare withother peoplenot on myapplicationLackingfacilityKitchenBathroomInside ToiletHot Water SupplyOutdoor drying spaceLiving roomGround floor storage for pushchairs, wheelchairsDo you have central heating and/or storage heaters? Yes NoDo you have a fixed gas or electric fire? Yes NoDo you have freestanding heaters, for example calor gas or electric heaters not fixed to a wall? Yes NoAbout any serious disrepair in the homeYour landlord is responsible for carrying out repairs. The Council’s Housing Improvement Officer will carry out aninspection if you are experiencing problems with the property relating to disrepair. We will only award points to yourapplication if Private Sector Housing are satisfied that all necessary steps have been taken to put the repair right.Leaking roof or wallsRotting wood, for example floorboardsDampFaulty or old electrical wiringIf you have applied with a joint applicant who is living at a different addresshave you lived together before?Why are you not living together now?YesNoPage 7

4 Health and Special NeedsDo you or anyone listed on your application have any medical/healthissues or special needs that are affected by your current housing? Yes NoIf YES, give name(s) of the person(s) and briefly describe their conditions:We will send you a separate medical form for each person you have listed with health issues or special needs for you tocomplete and return to us. The council’s Medical Panel may award medical points if your medical condition is affected byyour current housing.Do you or anyone on the application need support for any of the following reasons?Tick [✓] the boxes if you receive support from any of the following:Social ServicesMental Health ServicesYoung Person Leaving CareHealth VisitorOffender Manager/ResettlementOther – please describeFloating Support ProviderOccupational TherapistIf YES, please give their name and contact details:NameAddressPostcode:Telephone No.Is your current housing specially adapted for a disability? Yes NoIf YES, please describe:Do you have any pets? Yes NoIf YES, what pets do you have?Some housing providers do not allow pets in their properties:Would you be prepared to make other arrangements for your pets to increaseyour choice of properties? Yes NoPage 8

5 About where you have lived beforeHave you ever held a council or RSL (housing association) tenancy before? Yes NoIf YES, give address:Do you owe any rent arrears to a council or RSL (housing association)? Yes NoHave you ever been evicted or lost a tenancy before? Yes NoIf YES, give reasons:Do you owe any rent arrears to a current or former landlord? Yes NoIf YES, give name and address of your current or former landlord:Amount owed:Is there an arrangement to repay? Yes NoHas a Notice to Quit been served on you at your current address? Yes NoIf YES, give the date the notice is due to expire:Please provide a copy of your Notice to QuitDAY MONTH YEARHave you or anyone on your application been guilty of an anti-socialbehaviour offence which has led to action being taken against you? Yes NoIf YES, give details:Page 9

6 About your incomeYou need to tell us about how much you earn, if you are working and about any benefits,maintenance payments or pensions you may be receiving whether you are working or not.WorkingPlease [✓] tickAre you currently in employment? Yes NoIs your joint applicant employed? Yes NoIf YESApplicantOccupationName, address and telephone number of employerAverage Take-Home Pay or SalaryTick [✓] Weekly (W) or Monthly (M)Amount (W) (M)£Joint ApplicantOccupationName, address and telephone number of employerAverage Take-Home Pay or SalaryTick [✓] Weekly (W) or Monthly (M)Amount (W) (M)£National Insurance No(s)You need to tell us what your National Insurance Number is:ApplicantJoint ApplicantBenefitsPlease indicate in the boxes provided if payments aremade W (Weekly), M (Monthly), F (Fortnightly). If othertimes, please state:ApplicantAmountand how oftenreceivedJoint ApplicantAmountand how oftenreceivedChild Benefit £ (W/M/F) £ (W/M/F)Income Support £ (W/M/F) £ (W/M/F)Job Seeker’s Allowance £ (W/M/F) £ (W/M/F)State Retirement Pension £ (W/M/F) £ (W/M/F)Occupational Pension (inc. SERPS) £ (W/M/F) £ (W/M/F)Disability Living Allowance (DLA)/Attendance Allowance £ (W/M/F) £ (W/M/F)Incapacity Benefit/ESA £ (W/M/F) £ (W/M/F)Other Benefit £ (W/M/F) £ (W/M/F)TOTAL INCOME (sum of the above) £ (W/M/F) £ (W/M/F)Child Tax Credit (CTC) £ (W/M/F) £ (W/M/F)Working Tax Credit (WTC) £ (W/M/F) £ (W/M/F)Pension Tax Credit (PTC) £ (W/M/F) £ (W/M/F)Page 10

Do you have any savings, capital or investmentsIf YES please complete the information belowTotal AmountAnnual InterestYesNo7 For home owners onlyDo you, your joint applicant (if applicable) or anyone else on your applicationown or part own any property (even if you are not living there)? Yes NoHave you, your joint applicant (if applicable) or anyone else on yourapplication previously owned a home within the last FIVE YEARS? Yes NoIf you answer YES to either of the above, please fill in the boxes below. Include any property ownedabroad by you or any person on your application.Current home owner or part home ownerApplicantJoint ApplicantWhat is the current value of your home? £ £What is the amount of mortgage outstanding? £ £Home or part home sold within the last FIVE yearsAddress of property sold:Reason(s) for sale?When was it sold?How much was it sold for? £How much mortgage was outstanding? £How much equity did you receive? £Please supply a copy of the completion statement with this applicationAny other relevant information:8 Choosing where you would like to liveYour choices do not restrict you in any way in the future because we operate a choice based lettingsscheme. Your choices do however help to inform future developments.Folkestone (including Sandgate)Hythe (including Saltwood and Seabrook)Marsh Towns (Dymchurch, St Mary’s Bay and New Romney)*Hawkinge (including Densole)*Elham Rural (Elham, Lyminge, Etchinghill, Peene, Stelling Minnis)*Sellindge Rural (Sellindge/Lympne)*Marsh Rural (Burmarsh, St Mary in the Marsh, Ivychurch, Newchurch, Brenzett, Brookland, Old Romney)*CheritonLyddPage 11

If you have ticked any boxes marked with a * please state whether you have a connection to that area.For local connection, you or your partner must meet one or more of the following criteria:a) Currently live in the parishb) Have previously lived in the parishc) Have current employment in the parishd) Have close family members currently living in the parishIf you have ticked any boxes please state the nature of you connectionAreaAreaAreaConnectionConnectionConnectionIf you have close family members aged 18 years or more (parent, brother, sister, children) living inShepway, give details:Name Address Relationship to you/joint applicantHow long has yourclose relative livedin Shepway?Type of accommodationDo you want to be rehoused into –Please [✓] tickCouncil accommodation? Yes NoRSL (housing association) accommodation? Yes NoHousing Co-operative (tenant managed) accommodation? Yes NoIf you are a single person, would you consider a self contained studio flat?(combined Living Room/Bedroom)YesNoIf you are over 60 or registered disabled, would you considersheltered accommodation with visiting Supported Housing Officer? Yes NoIf you are over 50 or registered disabled, would you considersemi sheltered accommodation (with visiting Supported Housing Officer on call)? YesNoWould you consider enchanced/extra care sheltered housing? Yes NoLow cost home ownershipWould you be interested in low cost home ownership? (including part ownership/part rent) YesFor more information go to the homebuy.co.uk websiteNoPage 12

Armed Forces applicantsAre you a serving member of the armed forces?YesNoHave you previously served as a member of the armed forces?YesNoIf you answered yes to the above question, please state your date of discharge9 Additional informationPlease use this space to give as much information as possible that you think will be useful. Includewhy you need to be rehoused by the council and/or Registered Social Landlords. Please supply anysupporting documentation you may have.Page 13

10 Diversity monitoringPlease tick [✓] the box or boxes that apply to you and your joint applicant if you are applying with another personThe information you give in this section enables us to plan housing needs in Shepway and support localcommunities. It helps us make sure we manage the Shepway Housing Register fairly for everyone in the community.WhiteBritishIrishAny other White backgroundMixedYouYouYouJointApplicantJointApplicantJointApplicantWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other Mixed backgroundAsian or Asian BritishIndianPakistaniBangladeshiAny other Asian backgroundBlack or Black BritishCaribbeanAfricanAny other Black backgroundYouYouYouYouYouYouYouYouYouYouYouJointApplicantJointApplicantJointApplicantJointApplicantJointApplicantJointApplicantJointApplicantJointApplicantJointApplicantJointApplicantJointApplicantChinese or other ethnic groupChineseAny other ethnic backgroundLanguagesWhat is your spoken language?What is your preferred language?YouYouYouYouJointApplicantJointApplicantJointApplicantJointApplicantLong-term disability or illnessDo you or anyone on your application consider yourself to have a long-termdisability or illness?YesNoPage 14