Application for Housing Please complete this form if you want to seek housing from the Council or a transfer from your current Council property. We assess your housing application in line with our Allocation Policy and you will be placed in a band which decides your priority on the housing register. OFFICE USE ONLY App. Date App. No Ack. Date Please return your completed form to Housing Services, Town Hall, Station Road, Clacton-on-Sea, Essex CO15 1SE. If you would like help to complete this form, please call at the Housing Services Reception at the above address or telephone (01255) 686466. Have you applied for housing before at a different address? Are you an existing tenant of Tendring District Council? Part 1 Details of you and your family Surname: You Surname: Your partner Title: Mr/Mrs/Miss/Ms First name: Date of birth: National Insurance No.: Title: Mr/Mrs/Miss/Ms First name: Date of birth: National Insurance No.: Address: Postcode: Telephone No(s): Email address: If you fail to provide a telephone number or email address your application may be delayed Tell us the name of everyone you want to be housed with you including yourself: Surname Forenames Sex Date of birth Relationship to you Self 1
Eligibility Have you come to live in the United Kingdom in the last 5 years? Are you seeking or did you seek asylum in the United Kingdom? If yes, has a decision been made on your asylum application? If you have answered Yes to any of these questions, we will send you another form to complete. But please continue with this one. Part 2 Address history What date did you move to your present accommodation? Day Month Year How long have you lived in the Tendring district? years If you live in another area, have you lived in the Tendring district in the past? l If you do not live in the Tendring district, do you have family who live in the area? Do you work in the Tendring district? If you have answered Yes to any of these questions, we will write to you for more information. Which local authority area do you currently live in? Please list below all previous addresses where you have lived in the last 5 years (attach a separate sheet if necessary) Addresses From month/year Dates To month/year Tenure (private rented, owned, council, housing association) 2
Have you been a tenant of any council or housing association? If Yes, please give the name of your landlord, the address of the property, the date you left and the reasons why you left: Name of landlord Address of property Date your tenancy ended Reasons for leaving If we need more information, we will write to you. Have you ever applied as homeless to this or any other council? Were you provided with accommodation by the council? Did the council accept that it had a duty to provide you with accommodation? Have you been given notice to leave your present home? If Yes, on what date must you leave? Are you a member of HM Forces? If Yes, please state your expected date of discharge. Are you currently serving a custodial sentence (such as in prison)? If Yes, please state your expected date of release. Are you currently in hospital or residential care? If Yes, please state your expected date of discharge. Please list any pets or animals you have: 3
Part 3 Your present home Type of tenure (please tick as appropriate) Council Owner occupier Living with family/friends Housing association Private tenant Shared ownership Other (please specify) Type of tenancy (please tick as appropriate) Assured shorthold Secure Regulated Temporary housing association Assured Tied occupation Temporary council Living with family / friends Other (please specify) Renting your home Name of your landlord Address of landlord Telephone number How much is your rent? Weekly Monthly If you receive Housing Benefit to help you with your rent, how much do you get per week? Do you have rent arrears? If Yes, how much do you owe? Owning your home Do you have a mortgage? If Yes, what are your monthly payments? Do you have any other secured loan on your home? If Yes, what are your monthly payments? 4
Do you have arrears? If Yes, how much do you owe? Mortgage Secured loan If you have arrears, is your lender taking any action against you? What is the estimated value of your home? How much is outstanding on your mortgage or your secured loan? Mortgage Secured loan We may need to write to you for more information about your housing and financial situation. Where you live now House If you live in a flat or maisonette, please state which floor Bungalow Flat Bedsitter flat Maisonette Sheltered accommodation Bed and breakfast Lower ground (basement) Ground First Second Third Other (please specify) Holiday park Other (please specify) How many bedrooms are in the property? How many bedrooms are available for you and your household? Do you have your own garden? Do you have a communal garden? Do you have clothes-drying facilities? Do you have heating? If yes, what type of heating do you have? Gas Electric Solid fuel Oil 5
Living room Do you have a living room? Is it for the sole use of your family? Is it shared with other people? How many people? Bedrooms Please list which members of your family sleep in each bedroom. Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Please give the approximate size of each bedroom Bedroom 1 ft by ft Bedroom 2 ft by ft Bedroom 3 ft by ft Bedroom 4 ft by ft Bedsitter flats If you occupy a bedsitter flat, please give the overall size of your accommodation ft by ft Do you have a separate kitchen? Do you have hot water? Do you have facilities for storing and preparing food? Do you share a kitchen? With how many people? Do you share a bathroom? With how many people? If you do not have a separate kitchen, are the following provided? (a) A sink with hot & cold water and draining board (b) Space for an oven/cooker (c) Food preparation and storage facilities (d) Suitable floor covering Bathroom / Shower room Do you have a bathroom or shower room? Do you have hot water? 6
Do you share a bathroom / shower room with other people? If yes, how many people do you share with? Toilet Do you have a toilet? Is it for the sole use of your family? If you share a toilet, how many people do you share with? PART 4 Your income Please state how much you receive of the following benefits. Income Support Retirement Pension Incapacity Benefit Disability Job Seeker s Allowance Working Families Tax Credit Other (please specify) If you have savings, how much do you have? If you or your partner are working, please state your income below. You per Your partner per How long have you worked for your current employer? Years How long have you worked in the Tendring district? Years Do you receive a private pension? How much do you receive? per 7
PART 5 Medical, welfare and special needs If your existing housing conditions are bad for you or a member of your household, we will take this into account. Are housing conditions affecting your health? How many people in your household have medical problems that are made worse by your housing conditions? We will send you separate forms about this, but please continue with this form. Welfare and special needs Are you, or is anyone applying for housing with you, pregnant? If yes, what is the expected date of confinement? Please tell us why you want a home with special features or facilities. Tick one or more of the boxes to show the reasons that apply to you (or someone in your household) Mental health problem Physical disability Older person who is frail Older person with physical disability Older person with mental health problem Age-related mental illness Degenerative or debilitating illness (eg Parkinson s disease, multiple sclerosis) Blind or partially blind Deaf or partially deaf On drug / alcohol rehabilitation At risk of domestic / other violence Living with HIV/Aids Young person at risk/ leaving care Learning disability At risk of sexual abuse Behavioural problems At risk of racial harassment / violence If you have ticked any of the above boxes, we may need to write to you for more information. If none of the above describes your situation, please state your needs in your own words below. I need special housing because Do you, or anyone in your household, need to use a wheelchair indoors? Do you, or anyone in the household, use a mobility scooter? 8
PART 6 Areas you prefer TOWNS AND COUNTRY AREAS WITH HOUSING Please tell us which area you would move to. Tick as many boxes as possible. Alresford Great Bromley Little Oakley Ardleigh Great Holland Manningtree Beaumont Great Oakley Mistley Bradfield Harwich Ramsey Brightlingsea Jaywick St Osyth Clacton Kirby Cross Tendring Dovercourt Kirby le Soken Thorrington Elmstead Lawford Thorpe le Soken Frating Little Bentley Walton on the Naze Frinton Little Bromley Weeley Great Bentley Little Clacton Wix Wrabness All areas considered Housing need To help us assess housing need in the district, please enter below your two preferred choice of area from the selections you have made above. Please state two preferred areas only. Preferred area 1 Preferred area 2 9
PART 7 Type of accommodation you prefer By ticking the boxes below, please show the type of accommodation you want. You may tick more than one box. a) PROPERTY TYPE b) NUMBER OF BEDROOMS House Bungalow Flat Studio Flat Maisonette Warden assisted housing Studio Flat One bedroom Two bedrooms Three bedrooms Four bedrooms Extra care housing c) If you have selected a flat or warden-assisted housing please tick the following boxes to show your choice of floors: Any floor Ground floor First floor Second floor Third floor Would you accept a flat above ground floor if the property is served by a lift? Some flats in warden-assisted housing are studio flats. Would you accept a studio flat in warden-assisted housing? PART 8 Housing associations Housing associations are non-profit making bodies who let accommodation in much the same way as Councils. There are several housing associations in the council s area and in the majority of cases, the council has nomination rights to their housing. Where it means earlier re-housing, the council will consider nominating you for a suitable property. The information we hold on you will be made available to a housing association if we nominate you to a one of their properties. If you do not want your details shared with a housing association please tick the box. Ticking the box could reduce your chances of being offered accommodation. PART 8A Low cost home ownership Please tick in the box if you would like further information about low cost home ownership schemes in the district? 10
PART 9 Ethnic monitoring We do not use information in this section to decide who receives an offer of accommodation. The information helps us to ensure that racial discrimination does not prevent households gaining access to Council accommodation. Our aim is to ensure that everyone has equal access to housing based on needs, regardless of race, colour, nationality or ethnic origin. Please choose one section from A to E and show your ethnic origin by ticking a box or, where appropriate, write in your cultural background in the box provided. a) White b) Mixed British English British Scottish British Welsh White and Black Caribbean White and Black African White and Asian Irish Any other white background (please write in) Any other mixed background (please write in) c) Asian or Asian British d) Black or Black British Asian British Asian English Asian Scottish Asian Welsh Indian Pakistani Black British Black English Black Scottish Black Welsh Caribbean African Bangladeshi Any other Asian background (please write in) Any other black background (please write in) e) Chinese or Chinese British f) Any Other Ethnic Background Chinese British (Please write in) Chinese English Chinese Scottish Chinese Welsh Chinese 11
PART 10 Other information Please give your reasons for applying for housing. The information you give will be used to assess your application so please give as much information as you can. Please use the blank pages at the back of the application if you need further space. 12
PART 11 Declaration The Council is committed to a policy of treating all housing applicants equally and will consider applications for tenancies from anyone in the district, whatever their race, colour, nationality or ethnic origin, religion, sex, sexuality, physical disability, appearance or marital status. I declare that to the best of my knowledge all information given to me on this form is correct. Your authorisation to disclose information I/We have applied to Tendring District Council for housing assistance under the terms of Part VI Housing Act 1996 (as amended). I/We understand that the Council will make enquiries about my/our circumstances in order to verify the information I/we have provided. I/We give permission to a representative of the Council to verify the information on my/our application, including any financial or medical details, under any or all of the following: Housing Act 1996 (as amended by Homelessness Act 2002) Data Protection Act 1998 Signed: (Applicant) Signed: (Partner) Date: Please remember to notify the council of any changes in your circumstances. 13
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