REGISTRATION FORM.

Transcription

1 REGISTRATION FORM Homes4U is a Choice based Lettings Scheme for rented properties owned by the Council and partner Housing Associations in the Vale of Glamorgan. The Council also uses this information to plan new housing developments.

2 2 Homes4U is the Choice Based Lettings Scheme the Council and local Housing Associations use to allocate rented housing. To be considered for these properties you have to be registered with Homes4U and then bid for properties in areas that you want to live in. The rented properties available are mainly social rented properties, but can also include intermediate rented properties which are more affordable than private renting. Homes are available across the Vale, in towns and rural areas. Properties include houses, flats and properties designated for older people, such as sheltered housing. Homes4U is used to allocate new-build homes; priority for these homes if often given to people with a local connection to the area. Homes4U is also used to help the Council plan for new affordable homes; what types of homes are needed and where. It is important that if you think you may need affordable housing, now or in the near future, you are signed up to the scheme. Filling in the form: You must fill in all the sections of the form as honestly and accurately as possible, as this is a legal document, and sign the declaration on page 19. If you do not complete all sections, this will result in your application being delayed. If you have any questions about HOMES4U or this application form please call the HOMES4U Hotline on This document is available in large print and other formats on request. Cewch y ddogfen hon mewn print bras a fformatiau eraill drwy holi. FOR OFFICE USE ONLY Membership Number Registration Date Band / Group Reference Number Bedrooms Required Property Type Reason Initial Original Banding Referred to Homeless Department Property Type GN / OP / AH

3 3 About you and your household 1. Applicant(s) details: Marital status: Forename: Surname: Any other name used: Date of birth: National Insurance. address: Lead Applicant Mr / Mrs / Miss / Ms / Other Joint Applicant Mr / Mrs / Miss / Ms / Other Preferred Home: contact Work: number Mobile: Relationship to Lead Applicant: Is this a joint application? How would you prefer that we contact you about your application? Post What is your language preference? English Welsh Phone Other (please state)

4 4 About you and your household (continued) 2. Who else would be living with you? (not including yourself or the second person included in the table above. You must include details of everybody you wish to be housed with you, including children and dependents.) Title: Mr / Mrs / Miss / Ms / Other Forename: Surname: Any other name used: Date of Birth: National Insurance. Lives at applicant s address: If, please state address: Relationship to Applicant: Access only Title: Mr / Mrs / Miss / Ms / Other Forename: Surname: Any other name used: Date of Birth: National Insurance. Lives at applicant s address: If, please state address: Relationship to Applicant: Access only

5 5 Title: Mr / Mrs / Miss / Ms / Other Forename: Surname: Any other name used: Date of Birth: National Insurance. Lives at applicant s address: If, please state address: Relationship to Applicant: Access only Please continue on page 20 if necessary 3. Are you, or anyone that you wish to be housed with, pregnant? If yes, please tell us who? If you or someone you wish to be housed with is pregnant please provide proof of pregnancy. This is required in order for your application to be given the correct priority status.

6 6 About you and your household (continued) 4. Lead Applicant s current address Current Address Address: Is this address: Privately rented Council rented Postcode: Date moved in: If you rent your home please give us details of your landlord: Landlord name: Landlord contact details or address: Rented from a Housing Association Owner Occupied Sharing with friends or relatives HM Forces accommodation Tied accommodation other If other please state: Please provide details of any previous addresses that you have lived at during the last three years (please continue on page 20 if necessary): Address: Previous Address 1 Previous Address 2 Postcode: Date moved in: Date moved out: Landlord name: Landlord contact details: Reason for leaving: Have you registered with HOMES4U before? If yes, do you know your previous membership number:

7 7 5. Joint Applicant s current address Current Address Address: Is this address: Privately rented Council rented Postcode: Date moved in: If you rent your home please give us details of your landlord: Landlord name: Landlord contact details or address: Rented from a Housing Association Owner Occupied Sharing with friends or relatives HM Forces accommodation Tied accommodation other If other please state: Please provide details of any previous addresses that you have lived at during the last three years (please continue on page 20 if necessary): Address: Previous Address 1 Previous Address 2 Postcode: Date moved in: Date moved out: Landlord name: Landlord contact details: Reason for leaving: Have you registered with HOMES4U before? If yes, do you know your previous membership number?

8 8 Your employment status and financial information 6. Employment status Lead Applicant Joint Applicant Employed full time: Self employed: Part time (under 30 hours): Unemployed: Retired: Are you or any joint applicant currently a member of the Armed Forces or preparing to leave? 7. Household income Please provide information about your WEEKLY income (excluding Housing Benefit): Lead Applicant Joint Applicant Total income from paid work (Gross/After Tax): Income from other benefits (excluding HB): Total weekly income: Do you receive Housing Benefit? If does HB cover all or part of your rent? How much HB do you receive per week? Full HB Part HB

9 9 8. About your savings and property Do you and/or your partner have savings and/or investments? If what is their current value? Do you own a property? If what is the approximate value? Do you have a mortgage? If how much is there left to repay? If you do not currently own a property, have you previously owned a property? Reasons for applying for housing 9. Why do you want to be considered for housing now or in the future? Please select your main reason from the list below: To be independent/set up own home To move to more suitable home For more affordable home To be nearer to family/friends To give or receive support Current home is too large/small Leaving hospital Other, please state: End of Assured Shorthold Tenancy Eviction or repossession order Homeless Asked to leave by family/friends Loss of tied accommodation Issue with property e.g damp Leaving prison

10 10 Connection to the Vale of Glamorgan 10. What is your local connection to the Vale? Please tick only one box below as we can only consider one reason for a local connection. Lead Applicant Joint Applicant I normally live in the Vale of Glamorgan I am employed in the Vale of Glamorgan My family live in the Vale of Glamorgan Other connection/s to the Vale I have no connection to the Vale of Glamorgan If you have family members living in the Vale of Glamorgan please provide their name, address and relationship to you: Title: Mr / Mrs / Miss / Ms / Other Forename: Surname: Address: Postcode: If you have ticked other connection/s, or are currently living outside of the Vale of Glamorgan please explain below: If you are leaving the Armed Forces, Higher Education or Prison, please give a date when you first enlisted or entered:

11 11 Where you live and your future preferences 11.Tell us about your current home? Is your home a: House Mobile home Self-contained bedsit/studio Flat Bungalow Caravan or boat Other (please state) Sheltered accommodation How many bedrooms does your home have? Double bedrooms Single bedrooms Total If this is a flat what floor is it on? Lower Ground Ground 1st Floor 2nd Floor 3rd Floor or above Does it have a lift? Do you have a bath or shower at your property? Bath Shower Do you have access to a second living room? Is your toilet/bathroom upstairs or downstairs? Do you need an extra bedroom due to illness or disability? Has the property been adapted for your needs or are there existing adaptations? Do you share any of the following: 12.Your future home What tenures are you interested in? Kitchen Upstairs Bathroom Downstairs Toilet Rented Homes Home Ownership Both What type of property are you interested in? Sheltered/Older Persons Accessible/Adapted General Needs

12 Your preferred area M4 We would like to know where in the Vale of Glamorgan you would like to live. This is likely to be the areas you have a local connection to, for example; where you work, children s schools or where you have family. Your choices in this section do not affect where you are able to bid on properties. You are able to bid on properties in any area. This information is used to help us plan where new properties are needed. Rail link to Bridgend & West Wales Junc. 35 Junc. 34 Junc. 33 Rail link to Bridgend Crown copyright. All rights reserved. The Vale of Glamorgan Council Licence Bridgend Pendoylan A4232 Ogmore -by-sea St Brides Major St Brides Major B4265 Wick Llandow/Ewenny Llantwit Major A48 B4268 MOD St Athan Llantwit Major Cowbridge B4270 St Athan Cowbridge St Athan A4222 Peterston-super-Ely Rhoose Cardiff International Airport B4265 A4226 A48 Wenvoe A4226 Wenvoe Rail link to Cardiff & London A48 A4050 Barry Cardiff A4231 A4232 Llandough Dinas Powys Dinas Powys Sully Sully Cardiff Cardiff B4267 Cardiff Penarth Aberthaw Power Station Rhoose Vale of Glamorgan Ward Boundaries Ward boundaries are approximate only. t to scale Barry Island Referring to the map above, please name your first choice area below: If you have chosen Barry or Penarth, please refer to the maps opposite to select your preferred ward area and tick the name of the ward as appropriate.

13 13 Penarth Road LLANDOUGH Dochdwy Road Penlan Road Windsor Road ST AUGUSTINE Sully Road Redlands Road CORNERSWELL Wordsworth Avenue Cornerswell Road Windsor Road Arcot Street Clive Place Beach Road Stanwell Road STANWELL St Peter s Road Castle Avenue Archer Road Victoria Road PLYMOUTH Lavernock Road Plymouth Road Esplanade Westbourne Road Barry Ward Boundaries Buttrills Castleland Dyfan Illtyd Baruc Cadoc Penarth Ward Boundaries Cornerswell St Augustine s Stanwell Plymouth Llandough Court Gibbonsdown This information is important for planning where future homes are needed. t selecting a preferred area will delay your application.

14 14 Medical, Mobility and Disability Information 14. Do you have any medical issues? Do you require adapted, accessible or level access accommodation, e.g. a property without stairs or suitable for wheelchair access? If you tick yes we will ensure that your details are registered along with the adaptations you need. You will also be referred to the Councils Accessible Homes Register which ensures that people with mobility issues or disabilities are given the best opportunity to access suitable housing. The Council and its partners currently have a limited number of adapted properties. Priority will be given to the person whose needs can best be met by the property available. A further assessment may be made prior to an offer of accommodation. Does anyone in your household suffer from a diagnosed medical condition or disability that will be improved by moving to alternative accommodation? If please give details below: Applicant Joint Applicant Name: Diagnosed medical condition/disability: Details of any medication being taken: Continue on page 20 if necessary. Please provide name and address of your Family Doctor Doctor s Name: Practice Address:

15 Do you have mobility or support issues? Do you have difficulty walking? If yes do you use any of the following: Walking stick Walking frame Wheelchair If you use a wheelchair do you use it: Indoors Outdoors Both Do you have difficulty accessing your property? Do you have any equipment to help you with steps or stairs in your current home? If give details: Please briefly explain how your current home affects your medical condition (continue on page 20 if necessary) Support. If you receive regular help or support from someone like a district nurse, occupational therapist, home help or support worker then please give this person s details below: Name: Occupation: Organisation: Telephone: Does anyone in your household need support to be able to live independently or develop independent living skills?

16 16 Preventing Homelessness The Homes4U Partnership is committed to preventing homelessness in the Vale of Glamorgan. We would be grateful if you could answer the following questions honestly so that we can ensure that correct action is taken where necessary. You may be invited to attend an interview to ensure you are given the best possible advice regarding your current housing circumstances. Do you consider yourself to be homeless or threatened with homelessness? Have you received a tice to Quit from your landlord? Are you being harassed by your landlord or anyone else? Do you have mortgage or rent arrears against which legal action has commenced? Have you recently left any of the following: Lead Applicant Joint Applicant Hospital Care home Prison Armed forces Are you being harassed at your current home? If please provide details (continue on page 20 if necessary): If you ticked yes to any of the above questions, you may be contacted by the Council s Housing Advice and Homeless service to find out further information.

17 17 Information and Declarations Homeswapper HOMES4U has joined the national mutual exchange scheme Homeswapper. If you wish to mutual exchange into another property and require information, please contact the HOMES4U Hotline on or visit: Evidence Supplied To ensure you receive the correct priority banding, please read through your application to check that the information you have given is correct. Please attach any of the following if applicable and tick to confirm the information has been supplied: Pregnancy certificate Access rights to children Medical / disability evidence Convictions tice of eviction Do you have any current, unspent or pending criminal convictions (except motoring offences are you subject to an anti social behaviour order; or civil injunction for anti social behaviour? If, please give details (Continue on page 20 if necessary):

18 18 Information and Declarations (continued) Have you or any other applicant been convicted under the Sex Offenders Act 1997 or been placed on the Sex Offenders Register? If, please give details (Continue on page 20 if necessary): Information Are you related to a Vale of Glamorgan Councillor, member of staff or board or committee member of one of our Homes4U partners? If, please give details:

19 19 Declaration Before signing this form below you are reminded of the implications of making a false declaration. It is the responsibility of the applicant to inform Homes4U immediately of any change to the information on this form. The information that you provide will be checked and verified. Anyone who knowingly signs a false declaration or knowingly withholds information may be guilty of an offence and might be prosecuted if the Homes4U partners gain evidence of an intention to obtain a tenancy by deception. A court may grant a possession order on the grounds that the landlord was induced to grant a tenancy by making a false statement made knowingly or recklessly by the tenant. The Council can contact other persons or organisations to obtain verification of any of the details that you have provided or obtain further information relevant to your application. We may use the information you give us on this form for the detection and prevention of fraud and, if necessary co-operating in anti-fraud measures. Information may be given to other organisations in line with the Data Protection and Freedom of Information Acts. If you have answered yes to any of the questions in the Preventing Homelessness section information may be shared with the Council s Environmental Health Department. Any data supplied by you on this form will be processed in accordance with Data Protection Act requirements and in supplying it you consent to the Council processing the data for the purposes that you provide it. All personal information will be treated in the strictest of confidence and will only be used by the Homes4U partners or disclosed to others for a purpose permitted by law. If you have indicated on this form an interest in Home Ownership, your data will be entered into the Aspire2Own database. I/We authorise the Police, National Probation Service, Social Services Department, doctor or other health professional, or any other Registered Social Landlord to disclose all or any of my personal details whether held on computer under the requirements of the Data Protection Act 1988, the Freedom of Information Act 2000 or contained in manual records held by the relevant organisation in reference to my application for housing. I am aware that this will involve the disclosure of personal confidential information, which is held on computer or manual files. Applicant 1 Signature Date Applicant 2 Signature Date PLEASE NOTE: WHEN A JOINT TENANCY IS REQUESTED BOTH APPLICANTS MUST SIGN THE FORM PLEASE NOW COMPLETE THE EQUAL OPPORTUNITIES FORM ON PAGE 22

20 20 Additional Information If you required extra space for any of your answers please use the next two pages.

21 21 Additional Information (continued)

22 22 Equal Opportunities Monitoring Form The Vale of Glamorgan Council is committed to achieving equality of opportunity. Please complete this form to help us to achieve this aim. GenderandGenderIdentity Disability At birth were you described as: Female Male What is your gender? Intersex Female Male Prefer not to say Are your day-to-day activities limited due to a physical or mental health condition, illness or disability which has lasted, or is expected to last 12 months or more? Age - limited a lot - limited a little What is your date of birth? / / National Identity How would you describe your national identity? Prefer not to say Welsh English Scottish rthern Irish British Other (please specify) Prefer not to say Ethnic Group White Welsh/English/Scottish/rthern Irish/British Irish Gypsy or Irish Traveller Other white background Mixed/multiple ethnic groups How would you describe your ethnic group? (please specify) White and Black Caribbean White and Black African White and Asian Other mixed/multiple ethnic background Asian/Asian British (please specify) Indian Pakistani Bangladeshi Chinese Other Asian background (please specify) Black/African/Caribbean/Black British African Caribbean Other Black/African/Caribbean background (please specify) Other ethnic group Arab Other ethnic group (please specify) Prefer not to say

23 23 Equal Opportunities Monitoring Form (continued) Sexual Identity Which of the following options best describes how you think of yourself? Heterosexual/straight Gay or Lesbian Bisexual Other Prefer not to say Religion What is your religion? Prefer not to say religion Christian (all denominations) Buddhist Hindu Jewish Muslim Sikh Any other religion (please specify) Marriage and Civil Partnership What is your legal marital or same sex civil partnership status? Single Married that is never married and never registered in a same sex civil partnership and living with husband/wife Separated Divorced Widowed Civil Partnership Separated Dissolved in a registered same-sex civil partnership and living with your partner but still legally in a same-sex civil partnership formerly in a same-sex civil partnership which is now legally dissolved Surviving Partner from a same-sex civil partnership Prefer not to say Your personal information will not be disclosed or shared with any other organisation. The information you provide on this form will be used by the Council to monitor access to housing services and to help us develop our policies and practices so that they include all sections of the community. Signature: Date: / /

24 Vale of Glamorgan Council Visible Services and Housing Civic Offices Holton Road Barry CF63 4RU HGT