Application Form, Mutual exchange

Application FormMutual ExchangeThe information you give on this application form will be usedonly for the purposes of the mutual exchange you are applying for.All the information will be treated confidentially for your housing purposes only.Answer all the questions. You must not move until you have our permission to do so.Coast and Countryside Housing Services will not give permission to move if you haverent arrears. If you need advice on filling in this form please ask a member ofstaff who will help you.● Use BLOCK CAPITALS.● Write in BLUE or BLACK ink only.● Tick [✓] the YES or NO boxes where asked.● Give all the information that is asked for.● Do not give false information – we will refuse the exchange.Ref. No. (if known):1 About YouYour surnameYour titleMr Mrs Miss MsYour addressYour telephone/mobile number(s)2 About your HouseholdTell us about everyone who will be moving with you.Your first namesPostcode:Your Date of BirthFull Name Male or Date of Birth Relationship Is this personFemale to you living withyou now?(M or F) YES or NO3 About your PropertyWhat date did your tenancy start?DAY MONTH YEARApplication Form Mutual ExchangeHow much weekly rent do you pay excluding any Benefit entitlements you receive?Is the type of property you occupy a –£Tick [✓] one answer onlyHouseBungalowMaisonetteBedsitFlatHow many bedrooms do you have?Please give the name, address and telephone number of your RSL (Housing Association) if you are not a tenant withCoast and Countryside Housing ServicesTelephone number:Page 1

4 AdaptationsDo you or any member of your family have any physical disabilities? YES NOIf YES, give name(s) and details of disabilityIs your property adapted for the disabled?If YES, what are the adaptation(s), e.g. grabrail, shower, ramping?YESNO5 PetsDo you have any pets? YES NOIf YES, what pets do you have?6 Have you ever been served with a Notice of Seeking Possession?YESNOIf YES, give the expiry date:Day Month Year7 About the tenant you want to exchange withTheir surnameTheir first namesTheir titleMr Mrs Miss MsTheir telephone/mobile number(s)Their addressPostcode:Is the type of property they occupy a –Tick [✓] one answer onlyHouseBungalowMaisonetteBedsitFlatHow many bedrooms do they have?8 DeclarationThe information on this form is true and I understand that I must not make any arrangements to move until I havereceived the written permission of my landlord.Your SignatureJoint Applicant’s Signature (if you have a joint tenancy only)DateDateNow return this application form to:Coast and Countryside Housing ServicesShepway Housing Centre3-5 Shorncliffe RoadFolkestoneKentCT20 2SQPhone 01303 851700Date Application received(For Office Use only)Page 2You must not exchange until you have been granted permission to do so by us.Tenants who owe rent will not be permitted to exchange until their rent account is clear.mutual exchange/04/03/1