APPLICATION FOR ACCOMMODATION

Transcription

1 MAIN OFFICE 54 Stryd y Dyffryn DINBYCH LL16 3BW taiclwyd@taiclwyd.com C YMDEITHAS TAI CLWYD AREA OFFICE Uned 8 Gweithdai Penllyn Heol Aran Y BALA LL23 7SP bala@taiclwyd.com APPLICATION FOR ACCOMMODATION If you need this form in a different format e.g. on tape, in Braille, please telephone, or call at your nearest office. Please return your completed application form either by hand, by post (you will need to place a large letter postage stamp on your reply) or . Please complete all sections. If the application is not completed in full, we will return it to you, and it will take longer for your application to be registered. Space is provided after each question for your answer, but you might need more space for your answer. If you do, please use the space provided on page 14 or use additional sheets of paper. Please remember that you need to include additional information whenever you see this icon.

2 1. PERSONAL DETAILS Please include as much details as you can. Important information includes National Insurance number, date of birth, full name and address. If you have an address, it would be useful if you could provide it. Please provide proof of your identity and current address i.e. electric bill, driving licence etc. Title Full Name Current Address Applicant Joint Applicant / Partner Post Code Telephone No. [Home] Telephone No. [Work] Telephone No. [Mobile] Address Date of Birth National Insurance Date moved into this address Correspondence Address (if different from above) Is your partner a joint applicant? Yes No Are you / joint applicant a tenant of your present home? Yes No If Yes, please state your landlord s full Name and Address: 2. YOUR HOUSEHOLD Please list all the people who will be rehoused with you: Full Name Male / Female Date of Birth Relationship to you Living with you now? Yes / No Do you receive any Child Benefit for children? Please list below: Are you or anyone listed above expecting a baby? Yes No If so, please enclose a copy of Certificate of Pregnancy or ante natal card. Name Date baby is due 2 APPLICATION FOR ACCOMMODATION

3 YOUR HOUSEHOLD [continued] If there are persons listed previously who do not currently live with you, please give details below: Name Currently living at... Why they don t live with you Access arrangements i.e. order, time which they spend with you Please give details of anyone who currently lives with you but will not be moving with you, stating reasons why: Name Male / Female Date of Birth Relationship to you Reason why they are not moving with you 3. YOUR PREVIOUS ADDRESS Please list below the previous addresses (for the past 5 years) of all applicants to be rehoused and indicate whether they were Council tenants, housing association tenants, owners or other. Previous Address in full From/To Landlord Name and Address Applicant Please state if you were / are owner or occupier Joint Applicant / Partner APPLICATION FOR ACCOM- It is also important that you list any anti-social behaviour issues there have been in the MODATION past, or any rent arrears you have had. This will enable us to correctly assess your application. We take a lot of factors into consideration; therefore, if you have had arrears, for example, on a previous tenancy, if there are reasons for this, then we will not necessarily deduct points from your application. Has any legal action been taken against you, your partner/joint applicant or any person who intends to live with you, for anti social behaviour such as harassment, nuisance i.e have you been evicted for any reason, or had an injunction or ASBO taken out against you, or have you been convicted of a criminal offence relating to a property/street/estate you have lived or visited, or for other issues such as rent arrears? If because of rent arrears, please give details in section 5 on page 5. YeS No If Yes, please give details:- APPLICATION FOR ACCOMMODATION 3

4 4. YOUR FINANCIAL SITUATION We need to know this information so that we can make sure that you qualify for social housing. If we feel that you may be suitable for intermediate housing (e.g. low cost home ownership), then we will contact you and discuss this option with you. You will need to submit proof if you own any property or land, or have sold any property or land recently and/or in the past. What is your gross monthly / weekly income? (excluding any benefit listed below) (Delete as applicable) Date employment started Number of hours worked Name and Address of Employer Applicant Monthly / Weekly Full time salary / Part time wages Joint Applicant / Partner Monthly / Weekly Full time salary / Part time wages Self Employed Date first became Self Employed What and how much benefit do you receive? Income Support Income Based Jobseekers Allowance Pension Credit (including savings credit) Attendance Allowance Disability Living Allowance Incapacity Benefit Industrial Injuries Disablement Benefit Industrial Death Benefit Contribution based Job Seekers Allowance Employment and Support Allowance Applicant Joint Applicant / Partner Maternity Allowance Retirement Allowance / Retirement Pension Severe Disablement Allowance War disablement benefit, War Pension or War Widow s Pension Widow or Widower s Benefit Working Tax Credit Statutory Sick Pay Statutory Maternity Pay Child Tax Credit Child Benefit Applicant Joint Applicant / Partner What other income does your household have coming in? What is the money for? Who gets it? How much? How often? If on housing benefit, does it cover the whole of the rent charged by your landlord. YeS No If not, what is your contribution Please give the approximate value of any savings or capital invested (for joint applicants, add the amounts together). Please ( ) For amounts over 16,001, please note the total. 0-3,000 3,001-5,000 5,001-8,000 8,001-16,000 Over 16,001 Does any member of your household own or partly own any land or property including the home you live in? YeS No If Yes, please give details and approximate value Have you sold any property (including land) YeS No If Yes, please give details 4 APPLICATION FOR ACCOMMODATION

5 5. RENT/MORTGAGE PAYMENTS We need to know this because if payments are unaffordable, then your application will be awarded points. You can get more details by contacting the office. How much is your current rent? weekly / monthly Are you in rent arrears with your current landlord? Yes / No If yes, please state amount Are you in rent arrears with a former landlord? Yes / No If yes, please state amount How much is your current monthly mortgage? Are you in arrears with your mortgage? Yes / No If yes, please state amount 6. RIGHT TO REMAIN IN THIS COUNTRY We need to know if you are subject to immigration control, as if you haven t got refugee status, or right to remain in this country, you may not have a right to apply for housing with us. Are you / joint applicant subject to immigration control? Yes No If Yes, please give details:- 7. YOUR CURRENT TENURE Homeless Applicants We need to know whether you are homeless or not. You will need to enclose a letter from your council about your homeless status or a valid notice in order that you can be awarded homelessness points. We also need a copy of your assured shorthold tenancy agreement, if that is the tenancy you have. If you have been placed in Council provided temporary housing, we need to know how long you have lived there as this can have an effect on the total number of points you ll have. Have you been assessed as unintentionally homeless and in priority need by the Council? If yes, please provide proof. Have you been assessed as unintentionally homeless but not in priority need by the Council? If yes, please provide proof. Yes Yes NO NO Have you been assessed as intentionally homeless, but in priority need by the Council? If yes, please provide proof. Have you been assessed as intentionally homeless and not in priority need by the Council? APPLICATION FOR ACCOM- Yes NO If yes, please provide proof. Have you been served with a Notice Seeking Possession of Property, but not within the Yes last 28 days of the Notice expiring? If yes, please provide a copy of the Notice. MODATION Are you a lodger or in tied accommodation with your job? Yes NO If yes, please specify. Yes NO NO Do you have an assured shorthold tenancy? Yes NO Have you been placed in temporary accommodation by the Council? Yes NO If yes, since when APPLICATION FOR ACCOMMODATION 5

6 8. YOUR CURRENT HOME This section is about the condition of your present home. Details will be confirmed during a home visit when you are being considered for accommodation. What are your current living arrangements? Please ( ). House Bedsit Shared House Bed & Breakfast Maisonette Flat Hostel Caravan / Mobile Home Temporary Accommodation Living with parents Private Tenant Living with relatives Armed Forces / Tied Accommodation Living with friends Short term accommodation provided by L.A Prison Other (Please specify) Is there a specific reason for these arrangements? Please give details. How is your home heated? Please ( ). Full Central Heating Electric Storage Heater Part Central Heating Coal Fire No Heating Other (Please state) If you live above or below the ground floor, on which floor do you live? (i.e. first, second, basement etc) The rooms in your home Number Number Double bedroom Kitchen Single bedroom Bathroom Living / Dining room Toilet We need to know if you share facilities with persons who are not members of your household Do you share any of the above rooms? Yes No If yes, please give details 6 APPLICATION FOR ACCOMMODATION

7 YOUR CURRENT HOME [continued] Services in your home Please if you have the service Please if you have the service Cooking Facilities Separate Kitchen Bath/Shower Water Provision Inside Toilet Condition of present property, please ( ) where appropriate: Dampness General disrepair e.g. need new windows Severe infestation of vermin Dangerous supply of services e.g. electricity Lack of fire precautions (flats only) 9. OVERCROWDING How many bedrooms are there in your current home, who sleeps in each room and details of their gender and age. Bedroom 1 Size of Bedroom Double / Single Occupant s Name Occupant s Gender and Age Bedroom 2 Bedroom 3 Bedroom 4 Other APPLICATION FOR ACCOM- 10. MEDICAL DETAILS MODATION We need to know if you have a medical factor which affects how you can live in your current home. Points will only be provided if moving into a Tai Clwyd property will improve this condition. A GP / Consultant s letter must confirm this. We always need confirmation from your GP or Hospital Consultant to confirm your medical points. Is any person included in your application suffering a medical problem or is presently receiving treatment from a doctor (GP or hospital)? Yes No If yes, you must provide a letter from your GP or hospital consultant, explaining how rehousing will improve your health. APPLICATION FOR ACCOMMODATION 7

8 11. WELFARE Do you or any person to be rehoused with you need special accommodation e.g. ground floor, separate bedroom, wheelchair access due to medical condition / requirements Please state below:- Name Disability requirements Do you or any person to be rehoused with you need to move to a specific location, for example closer to a close family member to offer or receive support, or to take up training or employment? Please note below: Evidence must be provided, e.g. letter from employer Name of person who will benefit from the move Address of contact (e.g. person to offer / receive care, employer or raining provider) Please specify details Do you or any person to be rehoused with you receive any support in your current accommodation? Yes No If yes, please ( ) where applicable A letter from the agency with details of the support would be useful Health Visitor Support Worker Social Worker District Nurse Warden CPN Psychiatrist / Psychologist Other (please specify) e.g. probation If you, or any person to be rehoused with you, do not currently receive support, do you consider that any of you might benefit from getting support if you were to be rehoused by Cymdeithas Tai Clwyd? Yes No If yes, please provide us with any additional information regarding your support needs. 8 APPLICATION FOR ACCOMMODATION

9 12. SOCIAL FACTORS Please list any issues that are relevant to you. Remember, we will need proof of this, so please make a copy of any supporting evidence you may have i.e. adopting or fostering children. Some of the issues will be verified by the Housing Officer i.e. sharing a home, no garden, living close to a main road etc. during the home visit. Are any of the following relevant to your application? Please tick ( ) Yes or No YES NO Harassment Racial Incidents Domestic or other violence Sexual Abuse Anti-social behaviour Applying or are fostering or adopting children Relationship breakdown Families living apart due to lack of space Sharing a home Families with children without a garden Families with children under 12 living above / below ground floor level Aged over 55 and requiring ground floor accommodation because of disability / illness Families living in potentially dangerous locations e.g. access to busy main road Lack of amenities because of location i.e. no shops, bus service etc. 13. WHERE DO YOU WANT TO LIVE? You can select up to 3 areas of preference, please indicate your order of preference 1st Choice 2nd Choice 3rd Choice APPLICATION FOR ACCOM- IMPORTANT Please tell us in your own words what connection (please supply dates) you have with the communities you have chosen e.g. currently living there, work there or have family there etc. If you currently live outside the community, what reasons do you have for needing to move there? Also, if currently living outside the area, but have lived there in the past, please MODATION note the number of years you have lived in the area of your choice. APPLICATION FOR ACCOMMODATION 9

10 14. YOUR CHOICE OF ACCOMMODATION Please state your choice. It s useful for you to remember that we try and match up the need with the number of bedrooms required i.e. a family of 5 people (2 adults 3 children) will be considered for a 3 bedroomed house. Likewise, single people or couples, may be considered for 1 bedroomed properties, or on occasions 2 bedrooms. Therefore it is wise for you to put down what you need. Of course, we will try and help you achieve what you want, but this won t always be the case. We also might on occasions, operate our Underletting Policy if there is a high density of children on some estates we will let you know if this is the case. What type of property would you prefer to move to? House Bungalow Flat Bedsit Maisonette How many bedrooms do you need? (number) If you have indicated a flat/bedsit/maisonette, which floor do you require? Ground / any with lift Any Do you need any of the following? Warden assisted housing or sheltered accommodation Ground floor accommodation because of disability / illness Wheelchair adapted property Level access shower Other adaptations (please specify below) 15. OTHER HOUSING OPTIONS If you are a Cymdeithas Tai Clwyd tenant or a tenant of another housing association or council you may wish to consider a swap with another similar tenant. If you would like to register for such a swap, please visit and if you are a Cymdeithas Tai Clwyd tenant, you can register free of charge. You may also complete our own mutual exchange form if you wish. Please indicate whether you need a mutual exchange form. YeS No Cymdeithas Tai Clwyd offers other means of affordable housing. If you feel that you would be interested in purchasing but can t afford full market housing prices, you may be eligible for assistance towards purchasing affordable housing e.g. shared ownership, discounted for sale schemes. If you are interested in exploring such options, please indicate below. YeS No If yes, we will send you a low cost home ownership form for you to complete. We offer 50% of all our lettings to local authority nominations. For some of our estates, the council may have greater nomination rights. It is essential therefore that you register your application with as many social landlords (i.e. council and other housing associations) who operate in the area which you wish to be rehoused. Please indicate below to which other landlords you have applied. 10 APPLICATION FOR ACCOMMODATION

11 16. OTHER We need to know if you have pets we have a pets policy. Will any pets be rehoused with you? YeS If yes, please tell us how many and what kind? No On occasions, relatives of Board or staff members may apply for housing. We need to know this, so that a stringent procedure is followed if it is likely such an applicant is considered for a particular property. Are you or any members of your household related to any Board or staff members of Cymdeithas Tai Clwyd? YeS No If yes, please indicate who. List anything that you feel is relevant to your application, but that you have not had an opportunity to mention so far. Any other information you feel is relevant to your application: Please continue in the space provided on page 14 or on a separate piece of paper if required. 17. DATA PROTECTION NOTICE Please read this section carefully. Cymdeithas Tai Clwyd will use your personal information (as provided by you in this application form and any additional information which you may give the Association for this purpose in the future) for all purposes in connection with your application for housing and for administration of your tenancy if you are successful. Cymdeithas Tai Clwyd may disclose this information for these purposes to service providers and agents who cooperate with the Association. By signing this form you consent to Cymdeithas Tai Clwyd processing your sensitive personal information for these purposes. Sensitive personal information can include health, ethnic origin or criminal record. You have a right to ask for a copy of information held about you (for which we may charge a small fee). 18. DECLARATION FOR HOUSING Please read this section carefully, before signing and dating your form. I/we (the applicant/joint applicants/partner) declare that: Cymdeithas Tai Clwyd may make the necessary enquires in connection with any information given by me/ us in order to verify it. I/we give permission for information to be disclosed to Cymdeithas Tai Clwyd by my current or previous landlords, mortgage lenders, support agencies, statutory APPLICATION bodies FOR (such ACCOMas Police and Social Services) and any other relevant professional body or individual. The information given on this form is true and I/we acknowledge Cymdeithas Tai Clwyd s right to verify all the information given. Cymdeithas Tai Clwyd will take legal action to end any tenancy which they have granted MODATION me/us as a result of a false or misleading statement made by myself/ourselves. Failure to keep Cymdeithas Tai Clwyd informed of any changes in my/our housing application circumstances may affect my position on the housing register or result in my/our application being cancelled. I/we must notify Cymdeithas Tai Clwyd of any changes. Applicant s Signature Joint Applicant s / Partner s Signature Date Date APPLICATION FOR ACCOMMODATION 11

12 19. EQUAL OPPORTUNITIES MONITORING ASSESSMENT You have a right not to complete this section. Cymdeithas Tai Clwyd is intent on providing equal opportunities to all, regardless of race, colour, religion, gender or disability. To enable us to monitor this policy please indicate how you would describe yourself. To ensure our records are as accurate as possible, please could you complete this form. Tick the appropriate boxes. APPLICANT 1 APPLICANT 2 GENDER Male Female Male Female Single Married Single Married MARITAL STATUS Widowed Widowed Separated / Divorced Separated / Divorced AGE Under & Over Under & Over DISABILITY Yes No Yes No COUNTRY OF BIRTH Born in UK Born elsewhere in EU (inc Rep. Ireland) Born outside EU Born in UK Born elsewhere in EU (inc Rep. Ireland) Born outside EU None Christian None Christian RELIGION Buddhist Jewish Hindu Muslim Buddhist Jewish Hindu Muslim Sikh Other Sikh Other HOW WOULD YOU DEFINE YOUR SEXUALITY? WHICH LANGUAGE DO YOU WISH TO RECEIVE CORRESPONDENCE? Welsh Other (please specify) English Welsh Other (please specify) English ETHNIC ORIGIN APPLICANT 1 White White British White English White Welsh White Scottish White Irish White Other W/Blk Caribbean W/Blk African W/Asian Other mixed background Chinese Asian British Indian Bangladeshi Pakistani Mixed Other Asian background Black/British African Caribbean Other Black background Gypsy Traveller Other ETHNIC ORIGIN APPLICANT 2 White White British White English White Welsh White Scottish White Irish White Other W/Blk Caribbean W/Blk African W/Asian Other mixed background Chinese Asian British Indian Bangladeshi Pakistani Mixed Other Asian background Black/British African Caribbean Other Black background Gypsy Traveller Other Do not wish to answer 12 APPLICATION FOR ACCOMMODATION

13 WHAT HAPPENS NEXT? i. Please check that you ve completed the form fully as blanks mean we will have to send it back to you, thus delaying registration. ii. This application form weighs heavier than a 1st or 2nd class stamp postage charge. Please ensure that you use the correct postage or you can download an application form via our website at and it back to taiclwyd@taiclwyd.com iii. We will check your application form, if we have all the information we need, we will register the details on the computer system. iv. If for any reason you cannot apply for housing with us, we will let you know why. v. We will get back to you within 10 days of having all the information we need. If we need more information from you, we give you another 10 days to send it to us. vi. Once your details are on our computer system, you will receive a letter from us listing all the points that you have been awarded. vii. We will write to you every 6 months asking if you want to remain on our waiting list. We will also send you a newsletter twice a year. This newsletter will try and give you an indication of how long you will have to wait, and give you other housing options. viii. We will only carry out a home visit to people who are shortlisted for housing. We will write to you to let you know when we will visit, and which property we are considering you for. There will be information about the property, for example approximate room sizes, location, local amenities, rent and service charges etc., so you can decide if you want to be considered for the property. ix. x. If you want to be considered, we will carry out a home visit to check your application and provide information on the property in question. APPLICATION FOR ACCOM- After the home visit, we will write to the successful applicant on the same day as the decision has been made (usually within 3 days of the home visit). Unsuccessful applicants will be notified within 10 days. MODATION xi. If at any time you wish to change details about your application, please contact your relevant Housing Administrative Officer. Some details can be adjusted over the phone, for example a new addition to the family (birth certificate required), whilst others will mean you will need to complete a new application form, for example change of address. If you want to change areas of choice it would be useful if you could explain in your own words why you want to be considered for a different location. APPLICATION FOR ACCOMMODATION 13

14 HOW TO COMPLIMENT OR COMPLAIN ABOUT THE SERVICE WE PROVIDE We have an information leaflet explaining how you can complain about our services you can obtain a copy by contacting your local office, or by visiting our website. If you want to compliment us, you can do this by post, or telephone etc. LOCAL LETTINGS POLICIES AND SECTION 106 AGREEMENTS On some of our estates, housing can only be provided through strict policies i.e. you must have a demonstrable local connection with the area in which you want to be housed. This is enforced by the Town and Country Planning Act On other estates, we might, with the cooperation of the residents and local community create a local lettings policy to tackle antisocial behaviour. We are committed to helping communities to continue to be safe places to live. SPACE FOR YOU TO PROVIDE ADDITIONAL INFORMATION Please note the question number your answer relates to here and on any additional sheets of paper you use. 14 APPLICATION FOR ACCOMMODATION