Low Cost Home Ownership Registration Form

Transcription

1 Low Cost Home Ownership Registration Form

2 Low Cost Home Ownership Registration Form This form is to register your interest in Low Cost Home Ownership opportunities within Wrexham County Borough. Your details will be passed on to relevant housing associations for consideration for any Low Cost Home Ownership opportunities that arise in Wrexham. Filling out this form only registers your interest and you will need to complete a further, more detailed application form when schemes become available. Once you have completed the form please post it to: Affordable Homes Team Cymdeithas Tai Clwyd 54 Stryd Y Dyffryn Denbigh LL16 3BW Telephone: Alternative Languages or Formats Would you like to receive this leaflet in a different format for example Braille, cassette or text only copy, or in a different language? If so, please contact Housing Strategy Department, Housing Services, Ruthin Road, Wrexham, LL13 7TU. Telephone number: Fax number: housingstandardsandstrategy@wrexham.gov.uk

3 Section 1 Eligibility Are you a British or European Union (EU) citizen? Yes No If the answer to the above question is no, have you been given indefinite leave to stay in the UK? Yes No If you have answered No to both the above questions, you are not eligible to register and should not fill out this form. If you are currently registered on any housing waiting lists held by the Council or Housing Associations, please state whose list you are on and your registration number if you know it: Please indicate your housing tenure preference (You can tick as many boxes as you would like): Type of Affordable Home Shared Ownership Homebuy Discount for Sale Please Tick if interested

4 Section 2 Basic Details Please complete the following information: Title First Applicant Joint Applicant/ Partner Full Name Current Address and Postcode Date Moved into this Address Telephone Number Address Date of Birth Marital Status National Insurance Number Relationship to First Applicant

5 Section 3 Your Current Home Please describe your current accommodation: (Please tick as appropriate) Are You: You Joint Applicant/ Partner Renting from Wrexham County Borough Council Renting from a Housing Association Renting from a Private Landlord In accommodation tied to your job An owner occupier or leaseholder In HM Forces Living with friends or family Homeless Other (please state) Please provide details of everyone who will live with you: Full Name Male or Female? Date of Birth Relationship to you/ joint applicant / / / / / / / / / /

6 Section 4 Your Housing Choice Please indicate your 1st, 2nd and 3rd choice areas from the list below: 1 st Choice Area 2 nd Choice Area 3 rd Choice Area You can also tick any other areas that you are interested in buying in. N.B We cannot guarantee we will have developments in all areas Wrexham Suburbs Bwlchgwyn Rhostyllen Gresford/Marford Rossett Holt Llay Gwersyllt Brymbo New Broughton Tanyfron Southsea Pentre Broughton Summerhill Brynteg Coedpoeth Minera Trevor Ponciau Johnstown Penycae Rhosllanerchrugog Ruabon Acrefair Cefn Mawr Chirk Glyn Ceiriog Pentre Maelor Penley Marchwiel Bangor on Dee Bronington Overton Other (Please state)

7 If you do not currently live in Wrexham County Borough please tell us why you wish to purchase in the area (i.e. live in the community in the past, working within the Borough etc.) Type of property required: Bungalow House Flat Number of Bedrooms required 1 Bed 2 Beds 3 Beds 4 Beds Please note: Only the need for a property will be considered rather than aspirations, e.g. a single person would only be registered for consideration for a 1 or 2 bedroom property. Section 5 Medical Factors The Disability Discrimination Act (DDA) 1995 describes a disabled person as anyone with a physical or mental impairment which has a substantial and long term adverse effect on their ability to carry out normal day to day activities. Do you/joint applicant or anyone else coming to live with you consider yourself to be disabled under the terms of DDA? Yes No Would this condition mean that you require an additional bedroom, or any adaptations to the property? Yes No If yes, please give details:

8 Section 6 Financial Information Please provide your current employment Information You Joint Applicant/ Partner Current Place of Work (including address) Occupation How long have you been in your present job? Is your job Permanent/ Contract/ Temporary? Please provide information on your household income You Joint Applicant/Partner Earnings State Benefit Private Pension per week/4 weekly/monthly * per week/4 weekly/monthly * per week/4 weekly/monthly * Savings per week/4 weekly/monthly * * Please delete as appropriate

9 If you are in receipt of a state benefit(s), please specify which benefit(s) If you have enquired about a mortgage, please specify how much you have been offered by a lender Is this amount: Based on your income only Joint Income If parents or friends are helping you with a deposit, please state the amount: If you/joint applicant currently own your own home, please state equity in property: If equity is to be divided with former partner, please state amount you will receive: Section 7 Other Information Please give us any other relevant information that you feel will support your application:

10 Section 8 Equal Opportunities Wrexham County Borough Council wishes to monitor the effectiveness of its policies and procedures as part of our strategy for improving customer service and satisfaction. The information you provide below will only be used by the Authority in complying with the requirement of the National Assembly for Wales in the monitoring of performance indicators and will be used in strict confidence for equal opportunities monitoring only. You Joint Applicant/Partner Gender Male Female Male Female Age Ethnic Origin White: British Irish European Other: Black: British African Caribbean Other: Asian: British Pakistani Bangladeshi Indian Sri Lankan Other: Mixed Race: White & Black Caribbean White & Black African White & Asian Other: Other Groups: British Chinese Chinese Other: White: British Irish European Other: Black: British African Caribbean Other: Asian: British Pakistani Bangladeshi Indian Sri Lankan Other: Mixed Race: White & Black Caribbean White & Black African White & Asian Other: Other Groups: British Chinese Chinese Other:

11 Section 9 Data Protection Notice Wrexham County Borough Council will use your personal information (as provided by you in this application form and any additional information which you may give the Council for this purpose in the future), for all purposes in connection with your application for low cost home ownership. Wrexham County Borough Council may disclose information for these purposes to housing associations, service providers and agents who carry out services on behalf of the Council. By signing the declaration overleaf you consent to Wrexham County Borough Council processing your sensitive personal information for these purposes. Sensitive personal information can include health and ethic origin. You have a right to ask for a copy of your information (for which we may charge a small fee) and to correct any inaccuracies in your information. Please read and sign the declaration overleaf, and then send the form to Cymdeithas Tai Clwyd, who operate the low cost home ownership register for Wrexham County Borough Council, at the following address: Affordable Homes Team Cymdeithas Tai Clwyd 54 Stryd Y Dyffryn Denbigh LL16 3BW

12 Section 10 Declaration I / We declare that to the best of my / our knowledge that the information given on this form is correct and complete. I / We hereby authorise Wrexham County Borough Council to disclose information on this form to other organisations in connection with my application, e.g. Housing Associations, Developers and Estate Agents. I / We will write to Wrexham County Borough Council, Housing Services, Ruthin Road, Wrexham, LL13 7TU should I / We wish to have my / our details removed from the Low Cost Home Ownership Register. I / We understand that signing this form gives full permission to use the data collected from this form. I / We understand that any false or misleading information supplied to Wrexham County Borough Council will cancel our registration on the Low Cost Home Ownership Membership Register. Signed Print Name (Applicant) Signed Print Name (Joint Applicant, if applicable) Dated: