Mid Market Rent Application Form

Transcription

1 About You Title First Name(s) Last Name Current Address Applicant Date Of Birth Daytime Number Mobile Number Address Preferred Contact Method How did you hear about MMR? Relationship to You Who else will be living in the property? First Name(s) Last Name Relationship to you Date of Birth Sex Reasons for Applying Preferences Area(s) Choice 1 Choice 2 Choice 3 Property Type(s)

2 Housing Application(s) Are you registered on the Fife Housing Register or other public sector landlord list? Yes No If YES please provide your application reference number: Employment Name Full/Part Time Gross Salary per Annum Employer s Name & Address Pay Frequency Please remember to enclose proof of your income for the past 3 months Household Income (per annum) Bonuses/Commission Sickness Benefit Unemployment Benefit Housing Benefit Bank Interest Superannuation or Pension from Previous Employment Working Families Tax Credit Child Benefit Child Maintenance Payments Widow s Pension Shareholder s Profits Other (Please Specify): Please remember to enclose proof of this income

3 General Information Has anyone ever taken action against you or anyone on your application for antisocial behaviour? (This would include written warnings, court action, previous evictions and Anti-Social Behaviour Orders). If YES please give the full name of person(s) against whom action was taken: Yes No Do you, or anybody you are applying with, have to register with the police under the Sex Offenders Act 1997 and/or the Sexual Offences Act 2003 Yes No If YES please give the full name of person(s) who have to register: Special permission is needed for us to offer accommodation to employees, committee members or their close relatives. Are you or anyone of your household a member or related to a member of staff or committee of the Association/Directors of Kingdom Initiatives? If YES please give details: Yes No Do you own a pet? Please note dogs are not permitted in properties where there is a communal/shared entrance Yes No If YES please give details: Disabilities Do you consider anyone in your household to be disabled? Yes No If YES, do you require a property which is adapted to meet their needs? Yes No If YES, please specify how best we can help to meet your needs.

4 Current Accommodation Home Owner Local Authority Tenant Registered Social Landlord (Normally a Housing Association or Housing Co-operative) Private Rented Tenant Lodger Living With Parents / Relatives Tied Accommodation Other (please state): First Applicant Current Landlord First Applicant Previous Landlord Property Address Previous Landlord Property Address Please provide details for the previous 3 years. Continue on a separate sheet if necessary.

5 Data Protection Statement We will use the information you give in this form, and in any supporting evidence you send us, to process your application for housing. We may pass the information to other agencies or organisations as allowed by the law and in accordance with our Registration with the Information Commissioner. Kingdom Initiatives Limited is registered under the Data Protection Act with the office of the Information Commissioner. Kingdom Initiatives Limited is the Data Controller for the purposes of the Data Protection Act. As the Data Subject you have the right to access the information we hold on you. If you wish to exercise this right please contact our office and ask for a Data Subject Access Request Form. Data Subject Express Consent In accordance with the Data Protection Act, information which is provided by you, which is defined as sensitive e.g. racial or ethnic origin, political opinions, religious or similar beliefs, trade union membership, mental or physical health, sex life, criminal records or allegations of criminal conduct, requires your express consent to enable us to process this information. It is therefore essential that you sign the form where indicated to confirm you are aware of the need for us to collect this information and to confirm your permission for this. Declaration I/We declare that to the best of my/our knowledge and belief, all the information given by me/us on this application is true. I/We understand that should I/we give false or misleading information my/our application may be cancelled and any offer for accommodation already made may be withdrawn. I/We have no objection to this information being verified and I/We undertake to notify you of any changes which may affect particulars supplied. Signatures Applicant s Signature s Signature (if applicable) Date Please return to the Development Administration team at the address shown below. Kingdom Initiatives Limited is a wholly owned subsidiary of Kingdom Housing Association Limited