Housing Application Form - Adactus Housing Group Ltd

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PART THREE - Continuedj) Does any member of your household who is to be housed with you,own or hold a tenancy of another property?YES/NOIf YES, please give details and reasons for you not living there: ..............................................................................................................................................................................................................................................................................................................................................................................................................................................PART FOUR - Previous Addressa) Please give details of every address where you have lived during the past five years:AddressFromToLandlord name, addressand telephone numberTenant/Owner/LodgerReasonfor leavingb) Have you in previous tenancies or in your current tenancy:-• Rented a property from Adactus Housing Association in the past?• Rented a property from a housing association, local authority or other private landlord?• Been served with a Notice of Seeking Possession, a Possession order, ASBO or been evicted?• Left without giving notice or without handing in the keys or damaged a property?• Left a rented property owing more than £100 in rent arrears?If yes, how much? £......................................Has an agreement been made to clear this debt?• Left before eviction for serious crime, e.g. drug dealing?• Ever used violence or threatening behaviour against a landlord,their employees, agents or contractors?YES/NOYES/NOYES/NOYES/NOYES/NOYES/NOYES/NOYES/NOIf you have answered yes to any of the above questions, please give more details:............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
PART FIVE - Accommodation Requireda) Please indicate in order of preference what type of property you require:(ie 1=1st Preference, 2=2nd Preference, 3=3rd Preference, etc)■ House ■ Supported ■ Sheltered Housing (55yrs+) ■ Sheltered with Extra Care■ Bungalow Accommodation ■ Sheltered Ground Floor (Mental health needs)■ Ground Floor Flat(16-25 years)■ Sheltered First Floor■ First Floor Flat■ Sheltered with Extra Care (55yrs+)b) How many bedrooms would you prefer? ...............................................................................................................If you require more bedrooms than might be considered reasonable in your circumstances, please explain yourreasons and if possible provide written evidence.c) Which areas would you like to live in?To help you choose the Association has provided a map with a list of all its accommodation. You can have asmany choices as you like but please only choose areas which you would consider:1st ............................................................................ 4th .................................................................................2nd ......................................................................... 5th .................................................................................3rd .......................................................................... 6th .................................................................................PART SIX - Reasons for Applying for AccommodationPlease tick why you are applying for accommodation:- Homeless or potentially homeless ■- Living in temporary or supported accommodation ■- Experiencing domestic violence or fear of violence ■- Suffering serious racial or other harassment ■- Overcrowded ■- Need a smaller home ■- Pregnant woman/children under the age of 12 living above first floor level ■- Living in poor conditions e.g dampness, lack of amenities ■- Need to move because of a relationship breakdown where children are involved ■- Medical condition made worse by current housing ■- Moving to be nearer to college/work ■- No specific housing need but would like to move ■Continued…
Page 1 and 2: Adactus Housing Association LtdRegi
Page 3: PART THREE - Your Present Accommoda
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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