Housing and Property Appmissions Forms

Transcription

1 APPLICATION FOR HOUSING PLEASE READ THE GUIDANCE BOOKLET APPLYING FOR HOUSING ASSOCIATION ACCOMMODATION IN RUTLAND BEFORE COMPLETING THIS FORM. This form is for registering your housing needs, if you are eligible or qualify. Registration does not guarantee that an offer of accommodation will be made. Please complete this form in BLOCK CAPITALS. If you need extra space to answer any of the questions, please attach extra sheets. Please ensure that you answer all questions, and supply any additional documents requested. Please also complete and return the enclosed Equality Monitoring Form. If there is information missing, we will be UNABLE TO ACCEPT YOUR FORM, and it will be returned to you. Rutland County Council has a duty to protect the use of public funds. The information you provide for your application may be used for the prevention and detection of fraud. The information may also be shared with other public bodies responsible for public funds for the same reason. Your information will be processed in accordance with the Data Protection Act When completed please return this form to: Rutland County Council Housing Options Team Catmose Oakham RUTLAND LE15 6HP Tel: housingoptions@rutland.gcsx.gov.uk FOR OFFICIAL USE ONLY V Date Received: By: Input Date: Input By: Surname: FT no: Application : HR or TR:

2 SECTION A: ABOUT YOU, YOUR JOINT APPLICANT AND YOUR HOUSEHOLD A1: Applicant(s) for housing These are the people who would be on the tenancy if you were offered a property. If two applicants live at different addresses, they should complete separate application forms. Applicant Details Joint Applicant Details Surname Surname First name(s) First name(s) Title Title National Insurance Number National Insurance Number Date of Birth Age Date of Birth Age Ethnicity Ethnicity Full Address and Postcode (if you do not have an address to register from, please provide a postal address) Full Address and Postcode (if you do not have an address to register from, please provide a postal address) Date moved to current address: Telephone Number Home Work Mobile address Date moved to current address: Telephone Number Home Work Mobile address A2: Other Household Members Please list everyone who you want to be housed with you. Surname First Name(s) Relationship to You Date of Birth Sex Age Their Address (if different) Ethnicity A3: Please list anyone in your household who is aged 16 or over, and also in full time education.

3 A4: If someone in your household lives at a different address, either full-time or part-time, why is this? (e.g. children who you have staying access to). A5: Pregnancy Are you, or anyone who will live with you if you are rehoused, pregnant? Name Date Baby Due: Name Date Baby Due: A6: Other People You Live With w List everyone you live with at present who will not move with you if you are rehoused. Surname First Name Relationship to You Date of Birth Sex SECTION B: ELIGIBILITY AND QUALIFICATION FOR HOUSING B1: Immigration If you, your joint applicant or anyone who wants to be re-housed with you is not a citizen of the UK, please provide details below: Name Nationality Immigration Status B2: Have you, or anyone who wants to be re-housed with you, lived outside the UK in the past five years? Name Country Date From Date To

4 B3: Armed Forces Service Have you or a joint applicant... been a member of the Regular Armed Forces? been injured or become ill as a result of service in the Reserve Forces? been the spouse/civil partner of someone who has died as a result of service? been accepted onto another Council s Housing Register? If you have answered yes to any of the questions in B3 above, please give details below: Name(s): Date of enrolment: Date of discharge (if applicable): Details of illness or injury: Name of Council and date accepted onto their Housing Register: B4: Have you, or anyone who wants to be re-housed with you, ever been convicted of a criminal offence? You do not need to tell us about spent convictions. Nature and Details of Offence(s) Date of Conviction B5: Have you, or anyone who wants to be re-housed with you, ever been served with an Anti-Social Behaviour Order or Injunction Order? If yes, please give details:

5 SECTION C: WHERE YOU LIVE NOW C1: What is your current housing situation? Home owner (no mortgage) Home owner (with mortgage) Housing association tenant Private tenant Tied accommodation Prison Shared ownership (part rent, part buy) Armed Forces accommodation Lodger Staying/lodging with family or friends House/flat share Hospital or nursing home Hostel, refuge or B&B Roofless Other (please give details) C2: Are you or your joint applicant in rent or mortgage arrears at your current address? If YES, please give details: Amount outstanding: How did this debt arise? Have you made an agreement with the landlord or mortgage lender to repay this debt? How long has this been in place? How much is this plan per week? Are you keeping to this agreement? C3: If you are a tenant/lodger: Name of landlord or agent: Address of landlord or agent: Landlord s Telephone: Rent: per week/month C4: What type of property do you live in? House Ground floor flat/maisonette Room in shared housing Bungalow First floor flat/maisonette Mobile home or caravan Basement flat/ Higher floor flat/maisonette Residential care maisonette (please state which floor) Other (provide details):

6 C5: Tell us about the rooms and facilities in your current home (this includes facilities in your home that are shared with people who are not moving with you): Do you have a bath or shower? Is this shared with other people who will not be rehoused with you? Do you have an inside WC? Is this shared with other people who will not be rehoused with you? Do you have a kitchen? Is this shared with other people who will not be rehoused with you? Do you have a living room? Is this shared with other people who will not be rehoused with you? C6: If you live in self-contained accommodation (not shared), please tell us how many living rooms/dining rooms and bedrooms you have: Number of living or dining rooms Number of double bedrooms Number of single bedrooms C7: If you live in shared accommodation, please tell us how many bedrooms you and your household can use: Number of bedrooms your household can use C8: What type of heating does your home have? Gas central heating Storage heaters Oil heating Coal fires Other (please give details) Please list any rooms in your home which have no form of heating: C9: Does your home have a hot water system? C10: State of repair of your home Is your home in a bad state of repair? If YES, please give details Has the Council s Environmental Services Team advised that your home is in need of repair or improvement? (Or another Council if you don t live in Rutland?) If YES, please provide us with their report.

7 SECTION D: PREVIOUS ADDRESSES D1: List all the addresses YOU have lived at in the past 5 years. Address Tenure (e.g. rented, owned, living with family) Were you the tenant/joint tenant or owner/joint owner? Landlord/agent s name and address Date moved in Date moved out Reason for leaving Address Tenure (e.g. rented, owned, living with family) Were you the tenant/joint tenant or owner/joint owner? Landlord/agent s name and address Date moved in Date moved out Reason for leaving Address Tenure (e.g. rented, owned, living with family) Were you the tenant/joint tenant or owner/joint owner? Landlord/agent s name and address Date moved in Date moved out Reason for leaving

8 D2: List all the addresses YOUR JOINT APPLICANT has lived at in the past 5 years. Address Tenure (e.g. rented, owned, living with family) Were you the tenant/joint tenant or owner/ joint owner? Landlord/agent s name and address Date moved in Date moved out Reason for leaving Address Tenure (e.g. rented, owned, living with family) Were you the tenant/joint tenant or owner/ joint owner? Landlord/agent s name and address Date moved in Date moved out Reason for leaving Address Tenure (e.g. rented, owned, living with family, lodger) Were you the tenant/joint tenant or owner/ joint owner? Landlord/agent s name and address Date moved in Date moved out Reason for leaving

9 D3: Do you or your joint applicant have any rent or mortgage debt outstanding for a former address? If YES, please give details for all debts: D4: Have you or your joint applicant been evicted from any previous address? If YES, please give details: Address Date of eviction Reason for eviction D5: Have you or your joint applicant been known by a different name at any address during the past five years? If YES, please give details: SECTION E: YOUR INCOME, ASSETS AND SAVINGS E1: Employment list all the employers you have worked for in the last year, with the most recent first. Please include all jobs and not just your main work and continue onto a separate sheet if necessary. You Joint Applicant Occupation or Job Title Employer Employer s address Address of Workplace (where you actually did the work, if the job is mobile please list the areas you worked in) What date did you start the job? What date did you finish the job? Is this permanent employment? How many hours per week? Gross salary (before tax and including regular overtime) Is this (please tick one box) per week per month per year Is this (please tick one box) per week per month per year

10 Occupation or Job Title Employer Employer s address Address of Workplace (where you actually did the work, if the job is mobile please list the areas you worked in) What date did you start the job? What date did you finish the job? Is this permanent employment? How many hours per week? Gross salary (before tax and including regular overtime) You Is this (please tick one box) per week per month per year Joint Applicant Is this (please tick one box) per week per month per year E2: Please list any benefits you receive (eg: Housing/Council Tax Benefit, Tax Credits, Income Support, Pension Credit, JSA/ESA, Universal Credit, Disability Living Allowance) E3: What is your annual income including any benefits you receive? Applicant Joint Applicant Under 10,000 10,001-20,000 20,001-30,000 30,001-40,000 Over 40,000 E4: Your Assets, Savings and Housing You Joint Applicant Do you own any land? Do you have any savings? Do you have any shares?

11 If YES, please provide details of these: Do you or your partner own, or part own, a property or land anywhere? If YES, what is the address? What is the estimated equity in this property? If you do not currently live in this property, please state why: List below all properties that you or your joint applicant have sold in the last 5 years You Joint applicant SECTION F: SUITABILITY OF CURRENT ACCOMMODATION F1: Is your current home unsuitable because you, or another member of your household, are disabled or ill, or have special needs? If NO, please go on to section G F2: Would your or another member of your household s medical circumstances improve if you moved home? If YES, please also complete a separate medical form. F3: Are there any special features that your household needs in a property because of an illness or disability? I cannot live in a property that does not have this. I would like this but could live at a property without it. Wheelchair access to property Wheelchair access within property Level access shower Over-bath shower Wheelchair accessible kitchen Ground floor bedroom Ground floor bathroom Other (specify) If you have said YES to any of these features, please explain why you need this: I do not need this feature.

12 SECTION G: INSECURE ACCOMMODATION AND HOMELESSNESS G1: Have you been asked to leave your current housing? If YES, please give details, including the date you have been asked to leave by. G2: Do you currently have a homelessness application with a local authority? If YES, please answer the questions below. If NO, please go to section H: Are you currently in temporary housing arranged by Rutland County Council? Are you currently in temporary housing arranged by another council s housing service? Are you currently waiting for a decision on a homelessness application that you have made? If you are in temporary accommodation arranged by another council and/or have made a homeless application there, please provide details below: Name of local authority Name of officer dealing with your case Contact phone number SECTION H: LOCAL CONNECTION Before completing this section, please look through the following list of areas: Ashwell Egleton Lyndon South Luffenham Ayston Empingham Manton Stoke Dry Barleythorpe Essendine Market Overton Stretton Barrow Exton Morcott Teigh Barrowden Glaston rmanton Thistleton Belton-in-Rutland Great Casterton rth Luffenham Thorpe by Water Bisbrooke Greetham Oakham Tickencote Braunston Gunthorpe Pickworth Tinwell Brooke Hambleton Pilton Tixover Burley Horn Preston Uppingham Caldecott Ketton Ridlington Wardley Clipsham Langham Ryhall & Belmesthorpe Whissendine Cottesmore Little Casterton Seaton Whitwell Edith Weston Leighfield Wing Lyddington

13 H1: Do you or your joint applicant have any immediate family living in these areas? (e.g. parent, brother, sister, son, daughter). Name Address Relationship to you Date they moved to this address H2: Have you or your joint applicant lived in any of these areas? Area Who lived there Address Date moved In Date left H3: Do you need to move to one of these areas to give or receive support? Area Who needs to receive support? Current address Who will provide support? Current address What support will be provided? H4: Do you or any other member(s) of your household have any other connection to any of these areas? Area Person with connection Nature of connection including dates

14 SECTION I: THE HOUSING YOU WANT I1: Are you interested in New Build Homebuy (also known as Shared Ownership housing)? This means you can gradually buy your home on a part rent/part buy basis. If you are interested, your details may be passed on to private developers. I2: What kind of housing do you want? Older persons / supported? General housing? Adapted housing? I3: What type of housing would you prefer? Please tick all the types of housing you will consider. Please note that you may not be entitled to go on the list for all types of housing. The waiting list guide includes details of what kinds of housing you are eligible for. House Maisonette Ground floor flat Bungalow First floor flat Ground floor studio flat Second floor flat First floor studio flat I4: Do you have any pets? Please note that some accommodation may not be suitable for pets e.g. flats If YES, how many pets and what kind? I5: Are you or any member of your household related to a member of staff or councillor of the Council, or a Board Member or a member of staff of any housing association operating in Rutland? If YES, please give details: I6: Which towns and villages do you want to live in? te that not all locations have all types of housing please refer to the Applying for Housing Association Accommodation in Rutland booklet to ensure that the areas you choose include properties that you are eligible for. ASHWEL Ashwell LCASTE Little Casterton AYSTON Ayston LYDDI Lyddington BARDEN Barrowden LYNDON Lyndon BARROW Barrow MANTON Manton BARLEY Barleythorpe MOVER Market Overton BELTON Belton MORCOT Morcott BISB Bisbrooke NLUFF rth Luffenham BRAUN Braunston NORMAN rmanton

15 BROOKE Brooke PICKW Pickworth BURLEY Burley PILTON Pilton CALDE Caldecott PREST Preston CLIPSH Clipsham RIDLIN Ridlington COTTES Cottesmore RYHALL Ryhall EDITHW Edith Weston SEATON Seaton EGLETON Egleton STOKED Stoke Dry EMPING Empingham SLUFF South Luffenham ESSEN Essendine TEIGH Teigh EXTON Exton STRETT Stretton GLASTO Glaston TICKEN Tickencote GTCAST Great Casterton THISTL Thistleton GREET Greetham TINWEL Tinwell GUNTH Gunthorpe TIXOVE Tixover HAMBLE Hambleton THORPE Thorpe by Water HORN Horn WARDLY Wardley KETTON Ketton WHISS Whissendine LANGHA Langham WHITEW Whitwell LEIGH Leighfield WING Wing OWEST Oakham West Alpine Close, Brooke Rd, Cheviot Close, Cold Overton Rd, Coleridge Way, Cotswold Walk, Derwent Drive, Graffham Drive, Grampian Way, Hectors Way, Hill Rd, Kings Close, Malvern Walk, Parkfield Rd, Pentland Court, Princess Ave, Snowdon Ave, West Rd, Westfield Ave, Willoughby Gardens OEAST Oakham East Ashwell Rd, Beech Rd, Bullfinch Close, Burley Rd, Chestnut Rd, Elm Close, Heron Rd, Ladywell, Nightingale Way, Plover Close, Queens Rd, Redwing Close, School Rd, Willow Crescent, Woodland View OCENT Oakham Centre Barlow Rd, College Close, Dean Street, Finkey Street, Gaol Street, Kilburn End, New Street, Prince George Ave,Purdy Court, South Street, Stables Court, St Annes Close, The Sidings, The Lodge, William Dalby Walk UPPNORT Uppingham rth Blackthorn Close, Glaston Rd, Hornbeam Lane, rth Street East, The Quadrant, Wades Terrace, Wilkes Gardens UPPSUTH Uppingham South Adderley Street, High Street East, Hillside, Mount Pleasant, Queen Street, Valley Court UPWEST Uppingham West Branston Rd, Cottesmore Rd, Dolphin Court, Gerard Court, Johnson Rd, Metcalfe Crescent, Newtown Crescent, Newtown Rd, Queens Rd, Samuel Close, Samuel Court, The Beeches, Thring Terrace, Willow Close I7: Are there any streets within the area you have chosen that you do NOT want to live in?

16 SECTION J: OTHER INFORMATION J1: If there is any other information that you would like us to take into account when assessing your application, please tell us here. J2: If you would like someone else to deal with your application on your behalf, e.g. a family member or friend, please provide their details below: Name: Address: Telephone number: Relationship to you: J3: If you are working with any other agencies, please provide details below (e.g. Social Care, Probation, the Citizens Advice Bureau)

17 SECTION K: AUTHORITY TO MAKE ENQUIRIES AND DECLARATION I declare that to the best of my knowledge, all of the information on this form is true, complete and correct. I understand that I must inform Rutland County Council of any changes in my circumstances and that any changes may affect my eligibility for housing. I must renew my application when a review form is sent to me. I give permission for Rutland County Council to contact individuals or agencies referred to by me on this form. Where necessary in order to process my application, other individuals and agencies such as Health Services, Social Care, Education, other Housing Services, CAB, the Probation Service, The Police, Courts and other Local Authority departments may be contacted. I give consent for any housing association to which I am nominated to pursue references from my landlord/previous landlords. All contacts will be made in the strictest confidence. Only information relating to my housing application will be requested Where other peoples personal information is given on this form, I confirm that they have consented to its use. I understand that information relating to this application will be placed on Rutland County Council s Housing Register database. I agree that references may be obtained from my current and former landlords. I understand that it is an offence to provide false information, withhold information or fail to notify the Council of any important changes in my circumstances, and I could be fined up to My application may be cancelled and if I am granted a tenancy as a result of false or misleading information, my tenancy may be ended. I understand that my details may be passed to housing providers for the purpose of nomination to one of their properties. I agree, where relevant, that this form can be used in a decision about any homeless application I make under Part VII of the Housing Act I understand that if I am placed in temporary accommodation, my details may be passed to The Bridge, an agency offering on-going support. Applicant s signature:... Dated:... Name of Applicant: (please print)... Joint Applicant s signature:... Dated: Name of Joint Applicant: (please print)...

18 SECTION L: DOCUMENTATION YOU MUST PROVIDE Please go through the following list to make sure that you provide all the information we need to assess your application. For each item, please tick to show if the item is enclosed or not required. If you do not provide all the evidence we need, we will return your application to you. Section on form What must be provided Enclosed t applicable A: About you, your joint applicant and your household Proof of ID for everyone who will be re-housed. This can be either a passport, photo card driving licence, identity card, or a birth certificate along with a passport sized photo. Proof of National Insurance Number must be provided for the applicant and joint applicant (e.g. benefit letter, payslip or National Insurance Card) Address - Proof of address for you, your joint applicant and every person over 16 who will be rehoused with you (e.g. utility bill, bank statement or other official letter) Dependent children You must provide proof either a recent Child Benefit Letter or Tax Credits Letter Access to children who have their main home elsewhere Please provide a letter from their main carer confirming how often the children visit you and how long they stay or a court order confirming access arrangements Pregnancy - A letter from your GP or midwife confirming your pregnancy and expected delivery date or form MATB1

19 B: Eligibility and qualification for housing C: Where you live now E: Your income, assets and savings Immigration status if anyone in your household is not a UK citizen and has Home Office documents regarding their immigration status, please provide these to us. Members and former members of the armed forces please provide us with proof of service or former service (e.g. Forces ID Card, sign up papers, discharge letter) Unspent criminal convictions- Confirmation of the offence and date of conviction (e.g. letter from Probation and licence agreement if applicable). Information about spent and unspent convictions can be found at ASBOs and Injunctions a copy of the order If you/your joint applicant are an owner occupier please provide a recent mortgage statement. If your home is in need of repair A letter or report from your Council s Environmental Services confirming the Housing Health and Safety Rating System risk factor. Employees - 2 recent payslips or a letter from your employer stating whether your employment is permanent or temporary and the hours per week you work (excluding overtime) or a copy of your contract. Self-employed a copy of your most recent tax return. If you receive any benefits or Tax Credits proof of the benefits you receive (e.g. recent award letters) If you/your joint applicant have sold a property within the last five years - Proof that you no longer have an interest in the property (Land Registry papers, solicitor s letter confirming sale, a completion statement, or repossession order)

20 F: Suitability of current accommodation G: Insecure accommodation and homelessness If your current housing is unsuitable because of someone s illness, disability or special needs please provide a separate medical form for each person who is ill or disabled or who has special needs. Medical forms can be obtained from RCC. If you have been asked to leave your present home Owner Occupiers please provide a letter from your mortgage lender. Tenants a notice from your landlord. Applicants living with family/ friends a letter from the person you live with confirming you have been asked to leave. If the form of ID that you have provided for each applicant does not contain a photo of them, please attach a passport-sized photo below Name: Name: Original documents can be handed to our Customer Service Team for copying and verification.