Empty Property Assistance (Cluster Programme) Interest Free Loan Enquiry Form for Owner Occupiers
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1 Empty Property Assistance (Cluster Programme) Interest Free Loan Enquiry Form for Owner Occupiers Please fill in this form to help the Council to assess your eligibility for financial assistance. All information provided will be treated in the strictest confidence at all times. Please read these notes carefully: If you wish to apply for an Interest Free Loan please complete all sections of this form. You must answer the questions as accurately and as honestly as you can so that we can assess your details correctly. By signing this form: 1. You agree to provide, if required, proof of income, assets and savings for example copies of your latest payslip showing year to date information, P60, benefit or pension letters, bank statements, savings books, share certificates, evidence of outgoing expenses, utility bills, and mortgage statements. If more than one person owns the property, each person must complete a copy of the financial section of the form unless you are a couple (either married, co-habiting or by civil partnership). Extra copies of the financial section are available on request. 2. You are enquiring about an interest free repayment loan towards the repair and renovation works of a property which you intend to own to bring it up to the Durham Housing Standard. 3. If your application is successful, a charge will be registered on the property until the loan has been repaid in full. 4. You understand that a loan is only available once you have ownership of your home. It is not guaranteed that a loan will be approved therefore you are advised not to start any work until you receive written approval. If you do start the work before you receive approval it is entirely at your own risk. Please liaise at all times with the officer dealing with your case. FOR OFFICE USE BY HIT DATE RECEIVED RECEIVED BY REFERENCE. 1
2 PART A ABOUT YOU Name(s) of Prospective Owner(s) in full: Current Address: Post Code: Application Agent/Contact Name Telephone. (home): Telephone. (work/mobile): Address of property for purchase and improvement: Post Code: How long has the property been empty for? YOUR DETAILS: Date of Birth Age N.I. Number YOUR PARTNERS DETAILS: Date of Birth Age N.I. Number COUNTY COURT JUDGEMENTS Are there any County Court Judgements against you or any of the other prospective property owners within the last six years? CREDIT RATING Do you or any of the future property owners have reason to believe that you/they may have a poor credit rating? Why? BANKRUPTCY Are you or any of the future property owners currently an undischarged bankrupt? DEBTS TO COUNCIL Do you currently owe any money to Durham County Council? E.g. unpaid council tax, costs for group repair works undertaken 2
3 If you have answered yes to any of the above questions please provide further information below: ABOUT THE PROPERTY What type is the property? (e.g. terraced, detached etc) How many bedrooms are there? Will you own the property freehold or leasehold? If leasehold please state number of years left on the lease What is the current value of the property? What is the estimated value of the property should the works be undertaken? Will you be taking out a mortgage to purchase the property? If yes please give the total amount YES NO What will be the length of time of the mortgage Mortgage Lender Details: Name: Address: Mortgage Account Number: Please give details of your proposed building insurance cover including the name of your insurance company. Please note that if you do not get building insurance then you will not be eligible for a loan. 3
4 YOUR FINANCIAL CIRCUMSTANCES INCOME Employment Details: Yourself Partner n Dependents Employers name Employers Address Weekly hours worked OFFICE USE ONLY Self Employed Earnings: If you or your partner are Self-Employed then you should provide either your most recent Audited Accounts or records of Income & Expenses for the last year of trading. Please state the nature of your business PART B INCOME: Please can you state the amount that you receive of: Wages Salary ( Net Take Home Pay) Self Employed Earnings Pensions Occupational / Private / Personal Pension State Retirement Pension Guarantee / Savings Pension Credit War Disablement Pension Benefits Child Benefit Child Tax Credit Working Tax Credit Income Support Maternity/Paternity Pay Adoption / Custodian Allowance Payments for Foster Children Employment and Support Allowance Incapacity Benefit Severe Disablement Allowance Statutory Sick Pay DLA/Personal Independence Payment Attendance Allowance Industrial Injuries Disablement Benefit Carer s Allowance Yourself Partner How often do you receive this amount? p p 4 OFFICE USE ONLY
5 Job Seekers Allowance Widowed Allowance / Payments Bereavement Benefit Other Income Personal Injury Payments Rental Income from other properties Student Grant Student Loan Interest from savings Educational Maintenance Allowance Income from Boarders / Lodgers Maintenance Payments Received Any other Income (please specify) TOTAL INCOME PART B (Continued) YOUR FINANCIAL CIRCUMSTANCES - OUTGOINGS AND COMMITMENTS Please state the amount that you pay You Your Partner out each month on the following: p p Office Use Future Housing Costs: Mortgage repayments Council Tax House insurance buildings/contents Future Utility Costs: Gas/Oil Electricity Water rates Telephone (including mobile/internet) Other Important Costs: Food General Living expenses (including social activities and hobbies) Court Fine Payments/CCJ Maintenance/Child Support 5
6 Other Costs (please specify) Loan Repayments: Any loans -secured against your home Other loans -not secured against your home (catalogue payments etc) Average Monthly Credit Card Repayments Travel Costs: Approx monthly cost of your car(s) Approx monthly cost of public transport Please indicate the number of vehicles to which these costs relate: PART C DECLARATION If you deliberately give false information to fraudulently obtain financial assistance it may result in prosecution I (We) declare that to the best of my (our) knowledge, information and belief the information in this form is correct. All property owners to sign the declaration. Property Owner 1 Name (print) Signature Property Owner 2 Name (print) Signature Date Date Counter Fraud Work, Data Protection and Fair Processing tification This authority is under a duty to protect the public funds it administers, and to this end may use the information you have provided on this form for the prevention and detection of fraud. It may also share the information with other bodies responsible for auditing or administering public funds for these purposes. All information provided by you is subject to the controls of the Data Protection Act 1998 and no details will be divulged without your authorisation except to the appropriate officers within the Council and any organisations involved in the processing of any financial assistance from the Council for which you have enquired / applied. 6
7 PART E - AUTHORISATION We may need to contact other organisations or other parts of the Council to ask them to provide more information about you. For instance, if you are in receipt of Income Support, Income Based Job Seekers Allowance or Council Tax Benefit, Guaranteed Pension Credit it may be possible for your enquiry to be processed more quickly if you give your permission for the Council to confirm this fact. You do not have to give your consent, or there may be certain people or organisations you don t want us to approach. If this is the case, remember that this may make it more difficult for us to make a proper assessment of how we can help. I/we authorise the Council to pass on information about me/us if it helps to process my/our enquiry, and I/we authorise the Department for Works and Pensions or the Council s Finance Section to confirm on request, that I/we receive the benefit I/we have indicated within this form. I/we agree to my/our details being passed to the Councils specialist loans administrator the Five Lamps Organisation. The Five Lamps Organisation is independent from the council and will help you and the Council to ensure the loan offered is right for you. The loans administrator will contact you and arrange a meeting, this service is free to you and you are under no obligation to accept any loan you may be offered. Name/s Signature/s Date Please return the signed application to: Durham County Council Regeneration & Economic Development Durham County Council St John s Square Seaham SR7 7JE privatesectorhousing@durham.gov.uk 7
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