Mortgage Rescue Scheme

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1 Mortgage Rescue Scheme Thank you for your interest in Wales & West Housing s Mortgage Rescue Scheme. We hope you find this form easy to fill in. We will contact you if we need more informa on or to discuss the outcome of your applica on. Some Useful Tips If you have any ques ons about your applica on or how to complete this form you should contact our the Affordable Housing Development Officer on Further informa on is available on our website: If you require this form in a different format please contact us. We offer an interpre ng service using The Big Word. Once you have completed this form you should return it to our Head Office at the address below. It is important that you complete all the ques ons as fully as possible. How to contact us: Post Head Office 3 Alexandra Gate Ffordd Pengam Tremorfa Cardiff. CF24 2UD Phone Minicom Os hoffech chi gael gwybodaeth mewn iaeth neu fformat arall, cofiwch ofyn i ni.

2 Please answer all ques ons as concisely and clearly as possible and provide evidence where requested. All answers given are treated with the highest level of confidence and are subject to the Data Protec on Act Occupiers Details: Owner Title: Surname: First Name/s: Date of Birth: NI Number: Home Tel: Joint Owner Title: Surname: First Name/s: Date of Birth: NI Number: Mobile: 2. Occupiers Details: Address: Post Code: 3. Please list all people currently living with you: Please give details of all other people who are currently living with you (e.g. children, parents, grandparents) if there is not enough space please con nue on the blank page at the back of this form. If you have a child/children to whom you regularly have access but are not currently living with you please also provide their details below. First Name Surname Rela onship to you DOB M/F Are they currently living with you?

3 4. The Property Date of Purchase Original Purchase Price: Es mated Current Value: Age of Property: Type of Property Number of Bedrooms Condi on of Property Flat Terrace Semi Detached Detached Other One Two Three Four Five Good Fair Poor Does the property have a garage? Does the property have any physical adapta ons (e.g. for a disabil Yes, please provide details below ity) No Other Informa on (Please include any other informa on about your property you consider relevant e.g. if your property is a flat, what floor is it on?)

4 5. Your Mortgage Please enclose copies of the suppor ng documenta on requested below as this informa on will enable us to make a decision on your applica on more quickly. Name of Lender Mortgage Commencement Date Mortgage Account Number Contact Telephone Number Amount of Mortgage Taken Please enclose copy of mortgage offer le er. Amount Outstanding to Date Monthly Payments Please enclose copy statements. Current Interest Rate Arrears Redemp on Figure* *The redemp on figure would be the amount of money required to pay off your mortgage including any redemp on penal es, you can request this from your lender. 6. Second Mortgage/Secured loan (if applicable) Name of Lender Mortgage Commencement Date Account Number Contact Telephone Number Amount of Mortgage Taken Please enclose copy of mortgage offer le er. Amount Outstanding to Date Monthly Payments Please enclose copy statements. Current Interest Rate Arrears Redemp on Figure

5 7. Other Unsecured Loans (con nue on the blank sheet at the back of the form if necessary) Name of Lender Lender Contact Number Amount of Loan Taken Please enclose copy of mortgage offer le er Amount Outstanding to Date Monthly Payments Please enclose copy statements Arrears 8. Court Ac on Have any of the lenders included in this form started legal proceedings against you because of arrears (e.g. possession order, have you been given a date to a end a court hearing). Or have you entered into an agreement with any of the lenders to pay off arrears? Please give details.

6 Please enter details of your income and outgoings as accurately as possible below and provide suppor ng informa on where requested. This will help us to assess what level of support you might need. 9. Employment Details Employment Status (Full me, Part me, Self employed, Unemployed, Re red) How many hours to do you work per week? Occupa on Employer How long have you worked there? What is your gross annual income? (Please provide copies of last six pay slips) Are you unable to work due to health reasons? 10. Income Details (Weekly) Owner Joint Owner Owner Joint Owner Jobseeker s Allowance Income Support or Pension Credit Tax Credit Re rement or Works Pension Child Benefit Incapacity Benefit or ESA Child Maintenance Non Dependants Contribu on Other Income 1 Other Income 2 Total Income

7 11. Outgoings Details Council Tax Water Rates Ground Rent or Service Charge Buildings & Contents Insurance Life Insurance & Pension Gas Electricity Other Fuel Housekeeping TV Rental & Licence Magistrates Court Fines Maintenance Payments Hire Purchase Vehicle Travelling Expenses School Meals and Meals at Work Clothing Laundry Phone & Mobile Phone Prescrip ons & Health Costs Child minding Other Outgoings 1 Other Outgoings 2 Other Outgoings 3 Total Outgoings 12. Debt Advice Have you received any financial/debt advice regarding your current situa on? Who provided you with this advice?

8 13. Suppor ng Informa on (Con nue on an addi onal sheet if necessary) Please provide an explana on below of why you are applying for mortgage rescue and also any addi onal informa on you think might support your applica on. Are you, or is anyone living with you: Yes/No Currently or previously employed by Wales & West Housing? Related to anyone working for Wales & West Housing? Related to a current or previous board member of Wales & West Housing?

9 14. Support Needs Do you consider yourself to have a disability? If yes please provide further details including whether you are registered as a disabled person. Do you or anybody else living at the property receive any support from social services, the health authority or other agencies? 15. Other Informa on Has a housing associa on ever evicted you or anyone living with you? Have you or anyone living with you been convicted of a criminal act not including spent convic ons under the Rehabilita on of Offenders Act 1974? Have you or anyone living with you been the subject of an An Social Behaviour order or an injunc on rela ng to an social behaviour?

10 15. Equal opportunity monitoring Owner Name Na onality Gender Ethnic Group please ck one box White Bri sh English Sco sh Welsh Irish Other (please specify) Mixed White & Black Caribbean White & Black African White & Asian Other (please specify). Asian/Bri sh Asian Indian Pakistani Bangladeshi Other (please specify) Black/Bri sh Black Caribbean African Other (please specify) Chinese/Bri sh Chinese or other Ethnic Group Chinese Any other background (please specify) Joint Owner Name Na onality Gender Ethnic Group please ck one box White Bri sh English Sco sh Welsh Irish Other (please specify) Mixed White & Black Caribbean White & Black African White & Asian Other (please specify). Asian/Bri sh Asian Indian Pakistani Bangladeshi Other (please specify) Black/Bri sh Black Caribbean African Other (please specify) Chinese/Bri sh Chinese or other Ethnic Group Chinese Any other background (please specify)

11 16. Declara on Please sign the declara on below. In the case of joint applicants both must sign. I/we declare that the informa on contained in this applica on is correct to the best of my/our knowledge. I/We understand that any false informa on knowingly given may disqualify me from further considera on for the scheme. I/We undertake to no fy Wales & West Housing of any change in circumstance that may affect this applica on. The informa on that you provide in comple ng this form will be treated as confiden al, in line with the requirements of the Data Protec on Act We may need to share the informa on that you provide with other departments or other relevant outside agencies in order to process your applica on. Consent is hereby given for Wales and West Housing to contact other persons/ organiza ons to obtain references, verify details provided by me/us or to obtain further informa on relevant to my/our applica on. If you need any help or advice on this ma er, please contact the Affordable Housing Officer on Applicant Signature: Date: Joint Applicant Signature: Date: Please return this form to the Affordable Housing Development Officer at: Wales & West Housing 3 Alexandra Gate Ffordd Pengam Tremorfa Cardiff CF24 2UD We will confirm receipt of your applica on within 14 working days of receipt.

12 Wales & West Housing is registered as a charitable associa on under the Industrial and Provident Socie es Act No 1965 No 2114R

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