Housing Application Form - Adactus Housing Group Ltd

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PART ONE - Personal Detailsa) Your date of birth: ...................................................................................................................................................b) Your National Insurance Number: ..........................................................................................................................c) Date you moved into your current address: ..........................................................................................................d) Are you making an application for a joint tenancy? YES/NOIf YES, please give the other person’s details:SurnameForename(s)Dateof BirthMale/FemaleRelationshipto ApplicantLiving with youat the momentYES/NOe) Are you presently employed? YES/NOf) If you are employed please give details of employer: .............................................................................................................................................................................................................................................................................Full time ■ Part time ■ Approximate weekly earnings: ................................................................g) If you are unemployed, please tick one of the following: Job seeker ■ Not seeking work ■h) If you have seen a property advertised, where did you see the advert? ................................................................i) Data Protection: We will ask you for a password before discussing the details of your application.Please write below what you want your password to be.In case you forget please give us a question that will prompt your memory...................................................................................................................................................................................................................................................................................................................................................................PART TWO - Details of Persons to be Houseda) Please give the following details for everyone who is going to be living with you when you are housed, pleaseinclude anyone not living with you at the moment.SurnameForename(s)Dateof BirthMale/FemaleRelationshipto ApplicantLiving with youat the momentYES/NOYES/NOYES/NOYES/NOYES/NOb) Please give the name of any of the above who will live with you who is pregnant and send written confirmationof the due date:.................................................................................................................................................................................c) If you have children who do not live with you, but who come to stay, please give details and written evidence:.................................................................................................................................................................................
PART THREE - Your Present Accommodationa) Please tick the type of property you live in now:■ House ■ Bungalow ■ Ground Floor Flat ■ Upstairs Flat■ Bedsit ■ Hostel ■ Mobile Home ■ Friends Floor■ B&B ■ Caravan ■ Street/Homeless ■ Squat■ Sheltered Ground Floor ■ Sheltered Upstairs ■ Other(If you are homeless, please refer to the evidence form for information).b) How many bedrooms are there in the property? ..............................c) How many adults are living with you? ..............................d) How many children are living with you? ..............................e) Do you live in a rented property? YES/NOIf YES, please tick one of the following; (if NO, go to question f, below)■ Rented from the Council■ Privately Rented■ HM Forces■ Rented from another <strong>Housing</strong> Association■ Provided by employer■ OtherName and Address of Landlord: ..................................................................................................................................................................................................................Telephone Number: .........................................................................................................How long have you lived at this address?: .........................................................................................................How much rent is charged? £ ......................................................................................................Do you receive <strong>Housing</strong> Benefit?YES/NOf) Do you own or have a mortgage on the house you live in? YES/NOg) Please tick which of the following you and your household have:Shared withUse for yourself None another householdToilet ■ ■ ■Kitchen ■ ■ ■Heating ■ ■ ■Hot Water Supply ■ ■ ■Bath or Shower ■ ■ ■h) Is your home in a poor state of repair? YES/NOIf YES, please give details: ........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................i) Do you have any pets? YES/NOIf YES, please say what and how many: ..................................................................................................................................................................................................................................................................................................
Page 1: Adactus Housing Association LtdRegi
Page 5 and 6: PART FIVE - Accommodation Requireda
Page 7 and 8: PART EIGHT - Emergency ContactPleas
Page 9 and 10: ADDITIONAL INFORMATION
Page 11 and 12: OFFICE USE ONLYDate Received:Applic

Housing Application Form - Adactus Housing Group Ltd

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