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1 Help to Buy South West Application Form Please circle the correct answers Would you consider buying a home? Would you consider renting a home? Yes / No Yes / No I/We can confirm that our household income is under 60,000 If applying to buy, I/we can raise at least 2,500 to cover fees and understand mortgage lenders may require a deposit Yes / No Yes / No If applying for a particular development, please state which one: If you know the name of the housing association or developer building the development, please write it here: Application Form Please fill in this form in BLOCK CAPITALS and black ink then send it back to us at Help to Buy, Templar House, Collett Way, Newton Abbot TQ12 4PH. Tel: Alternatively you can complete this application form on our website at info@helptobuysw.org.uk

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3 Application Form Please fill in this form in BLOCK CAPITALS and black ink then send it back to us at Help to Buy South West, Templar House, Collett Way, Newton Abbot TQ12 4PH. Tel: Alternatively you can complete this application form on our website at Household details Applicant 1 Applicant 2 Title: Mr/Mrs/Miss/Ms Mr/Mrs/Miss/Ms First name: Last name: Date of birth: DD/MM/YYYY / / / / National Insurance number Home telephone: Work telephone: Mobile telephone: address: Are you pregnant? Yes / No Yes / No Pregnancy due date: DD/MM/YYYY / / / / Are you in full time education? Yes / No Yes / No Relationship between 1st applicant and 2nd applicant (eg partner, friend, co-habitee etc) 3

4 Applicant 1 Applicant 2 Your current address: Postcode: Date you moved into this property: Your previous address: Postcode: Date you moved into this property: Does any member of your household Yes / No Yes / No have a long term disability? If yes, state the disability: Do you require wheelchair adapted Yes / No Yes / No accommodation? Who else will be living with you? Name Sex Date Of birth In Work? Relationship to applicant 1 4 Do you own any household pets? Yes / No Yes / No If so what are they

5 Where do you live / work? Local connections Some homes are only available to households who have a connection to a particular area. Please complete these questions as fully as you can. Where do you currently live? Applicant 1 Applicant 2 Name of local authority Name of parish or ward Where do you currently work? Name of local authority Name of parish or ward Other local connection? Do you have a local connection to any other area? If so please complete the following: Name of local authority Name of parish or ward Nature of local connection: eg. born, previously lived or worked in area. Where do you want to live? Please list: Local authority Parish / Ward 5

6 Employment details Applicant 1 Applicant 2 Are you working? (please circle) Yes / No Yes / No Do you work for the Ministry of Defence? Job title/occupation: Employer s name: Employer s address & post code: Employer s telephone number: Are you permanently employed? Are you self employed? Are you on a fixed term contract? How long have you worked for your current employer? Income details (pounds only) Annual Income Applicant 1 Applicant 2 annually annually Total gross income from employment before tax & deductions (not including overtime and bonuses) Total amount of savings and capital (Please state if joint) Total gross amount of any overtime, bonuses or commission, please state amount: 6

7 Calendar monthly income ( only) Applicant 1 Applicant 2 Total net pay (take home pay) or pension after tax and deductions Working Tax Credits Child Tax Credits Child Benefit Disability Allowance Guaranteed Child Maintenance Other income Outgoings monthly monthly Total balance of all outstanding loans which have more than 6 months to run. Total monthly payment on outstanding loans (only include student loan if you have started making payments) Total outstanding balance on all store / credit cards Total rent or mortgage payments each calendar month Total of any other calendar monthly outgoings Have you had a County Court Judgement (CCJ) registered against you in the last 3 years Current housing circumstances Are you currently? (Please tick) A council tenant A housing association tenant Renting from your employer Living with family or friends Renting privately A current home owner Existing shared owner Homeless or temporary accommodation provided by the council Other Yes / No _ Yes / No _ 7

8 Applicant 1 Applicant 2 How many bedrooms does your current home have? Is it a flat or a house? If it is a flat, on what floor? Does it have a lift? If you are currently renting, please give the name of your landlord: Landlord s address & post code: Landlord s telephone number: Are you on a council housing or housing association waiting list? If you are on a council waiting list, please say where: And give your reference number: Only complete this section if you are a current home owner (includes caravans, mobile homes, houseboats etc) What is the reason for your application (e.g. relationship breakdown)? How much equity do you estimate you have available? Is your property on the market? Yes / No Yes / No Has the property been sold? Yes / No Yes / No 8 Additional questions Are you related to a current or former Yes / No Yes / No committee/board member/ council member or officer of a housing association? If yes, please tell us their name and which housing association/local authority: Where did you hear about us?

9 Equal opportunities It is against the law and our equal opportunities policy to discriminate against anyone because of their sex, colour, race, religion, disability or sexual orientation. In order to ensure that we do not discriminate, we need to keep records. If you do not answer these questions it will not affect your application in any way. Sensitive personal data such as ethnic origin and physical or mental disabilities are required under the Equal Opportunities Monitoring statute. How would you describe your ethnic origin? Asian or Asian British Indian Pakistani Bangladshi Any other Asian background Black or Black British Caribbean African Any other Black background Chinese Mixed White & Asian White & Black African White & Black Caribbean Other Ethnic Group White British Irish Any other White background Prefer not to state What is your sexual orientation? Bisexual Gay man Gay woman/lesbian Straight / Heterosexual Prefer not to state What is your religion? Atheism Buddhism Christianity Hinduism Islam Judaism Sikhism Other No religion Prefer not to state What is your nationality? Applicant 1 Applicant 2 Other Other household household member member 9

10 Important information and declaration All applicants must sign this page Help to Buy South West will only use the given personal data of all applicants for the purpose of processing your application for housing and will hold your information in accordance with the Data Protection Act All information you give us on this form (and information resulting from contact with your landlord and/or employer) may be shared with the same only in relation to this application. All information will be treated in the strictest confidence. We, other Help to Buy Agents, partner housing associations and developers reserve the right to take up any references relating to applicants as we consider necessary and may also search the files of any credit reference agency which will keep a record of any such request. We must protect the public funds we handle and so may use the information you have provided on this form to prevent and detect fraud. Under Section 29(3) of the Data Protection Act 1998, the information may be disclosed for purposes of crime prevention and detection. We may also share this information for the same purposes with other organisations who can help you find a home. The information may be used for statistical surveys, which means we may pass this information in confidence to the Dept for Communities & Local Government, Homes & Communities Agency, local authorities, housing associations, developers and agencies working on our and their behalf. Declaration: It is a criminal offence to knowingly or recklessly make a false declaration or withhold information reasonably required in connection with your application. I/We have read the above and confirm that I/we have provided accurate and up to date information relating to my/our application for home ownership. I/ We understand that if it is found that false information has been given to obtain housing either knowingly or recklessly, appropriate legal action may be taken and the housing association may seek possession of any leasehold tenancy granted. (Translation service available if required). I/We understand that if I/we are a council, housing association or other public sector tenant, I/ we will be required to give up my/our rented home on the day of completion if I/we buy or rent a home through any of the housing associations offering homes. I/We authorise Help to Buy South West to pass information to other Help to Buy Agents, partners, credit reference agencies, estate agents, financial advisors, housing associations, developers and mortgage lenders. Signed: (First Applicant) Date: Signed: (Second Applicant) Date: 10

11 Thank you for completing the application form. What happens next? You will be sent a written response from us within 4 working days advising whether you are eligible to be added to the register. If accepted you are encouraged to carry out a search for properties on our website that are currently available in your area of choice. The information includes appropriate contact details for each provider. Alternatively, you can contact our customer services team and request a property newsletter. You should consult an independent financial advisor. Please see details of our panel on our website. We will also send you a paper copy in our written response. Please note that any money paid in order to reserve a particular property is paid at your own risk. Applicants should avoid committing financially until a full financial check has been carried out by the provider selling the property. Once accepted on the register we will contact you every 6 months to confirm whether your circumstances have changed to ensure we keep our records up-to-date. If you wish, you can enter any changes directly on to the website. Please contact us if we can assist you further on tel or us at info@helptobuysw.org.uk 11

12 Help to Buy South West is managed by Sovereign Housing Association Ltd and Westward Housing Group Ltd in partnership. Templar House Collett Way Newton Abbot TQ12 4PH Tel: