Housing Transfer Application Form

Transcription

1 Housing Transfer Application Form

2 Housing Transfer Application Form 2 Complete this form if you are already a resident with Colne Housing and need to transfer into alternative accommodation. If you are over 55, retired from your main employment and want to move to sheltered housing, please ask for an Older People's Housing application form. We can supply this form in large print or a staff member can complete it with you, in person or over the phone. Just call us on ) About You Title: First name: Telephone numbers: Date of birth: Mr / Mrs / Miss / Ms / Dr / Prof or other: Surname: National Insurance : Your Partner s Details (leave blank if this is application is for one person) Title: First name: Telephone numbers: Date of birth: Mr / Mrs / Miss / Ms / Dr / Prof or other: Surname: National Insurance : Emergency Contact (in case we can t get hold of you) Name: Address: Telephone number(s): Their relationship to you:

3 More About You 3 Completion of this page is optional. However the more information you give us, the better placed we will be to help and support you. This information isn t used to identify you it ensures we treat everyone fairly. 1st applicant 2nd applicant Ethnic origin White British White Irish White Other Mixed White & Black Caribbean Mixed White & Black African Mixed White & Asian Mixed Other Asian or Asian British/Indian Asian or Asian British/Pakistani Asian or Asian British/Bangladeshi Asian or Asian British/Other Black or Black British Caribbean Black or Black British African Black or Black British Other Chinese Gypsy/Romany/Irish Traveller Other ethnic group Prefer not to answer Nationality Sexual orientation Please write in Heterosexual Homosexual (gay) Bi-sexual Prefer not to answer Religion or belief Please write in Prefer not to answer

4 Pets 4 Often whether or not your pet can be moved with you depends on the property you need to move to. For example it may not be possible to have a dog or cat in a flat. Do you have any pets that you will want to have living with you in future? - if so complete the section below Type of animal: Breed: We ask all our residents to sign a responsible pet ownership contract as a condition of receiving permission to keep their pet. Please ask for details. Your income Please tell us about your income and your savings. Give weekly figures. Salary: Disability Living Allowance (under 65 s only): Other: State or private pension(s): Income support /Jobseekers allowance/ Universal Credit: Total weekly income: Do you currently receive housing benefit towards your rent or mortgage payments? - per week To the nearest 100, please tell us the total value of your savings:

5 2) Your Current Home 5 Address (including post code): When did you move in? Which of these best describes the property you need to move to? One Bedroom Property Three Bedroom Property Two Bedroom Property Four Bedroom Property Do you have any special accommodation needs? An adapted property for people with disabilities A ground floor property A property with its own garden. If so, why? 3) Who Will Be Living With You? Full Name Date of Birth Sex (M/F) Their relationship to you Do they live with you full time If the children do not live with you full time please enclose details of any shared care arrangements. If you are currently in breach of your tenancy agreement (e.g. in arrears and failing to meet a repayment agreement, or being investigated for allegations of anti-social behaviour), a request to transfer may be declined.

6 4) The Home You Want 6 Tell us where you want to live. Please tick as many options as possible. For locations marked with a *, you may need to prove a local connection to that area (see section six). Area Tendring area Chelmsford City Babergh District Maldon District Uttlesford Colchester Braintree District Area Colchester Rural Location West Bergholt Wivenhoe* Great Horkesley West Mersea* Dedham Layer De La Haye* for those over 50 years of age only Bradfield for those aged over 55 years of age only Langham* Ardleigh* Property Types 2, 3 or 4 bed houses 2 bed flats 2, 3 or 4 bed houses 1 or 2 bed flats and 2 bed houses 2 bed flats and 2 or 3 bed houses 1 or 2 bed and 3 bed houses 2 bed flats 2 or 3 bed houses 2 or 3 bed houses

7 5) Medical Needs 7 Do you, or does anyone in your household have a medical condition which is being made worse because of where you currently live? If yes, please complete the enclosed Medical Questionnaire in your own words. Your completed form should be verified and signed by your GP or other medical practitioner and returned to us with this application. One medical questionnaire is required per household. Please note it is your responsibility to provide Colne Housing with the information we need to make an accurate assessment of your medical condition. We cannot request this information on your behalf, or pay any charges incurred in doing so. Medical priority will not be awarded unless your GP / medical practitioner has signed and verified your medical questionnaire. 6) Providing/Receiving Support Do you currently receive support from a family member living in the area you need to be moved to? If yes, please provide the details of the family member providing the care and what support they give you, please include their address and relationship to you. Do you currently provide support to a family member living in the area you need to be moved to? If yes, please provide the details of the family member receiving the care and what support you give them, please include their address and relationship to you.

8 7) Local Connection 8 Do you currently work in the area you need to move to? e.g. you need to move to Maldon and you currently work in Maldon. If yes, please provide the name and address of your employer. Name: Address: Do you have relatives currently living in the area you need to move to? If yes, please provide the name and address of your relative and their relationship to you. Name: Address: Relationship: Have you within the last five years lived in the area you need to return to? If yes, please enclose details of your former address, e.g. old bank statement/council tax bill. Please note you will not be considered to have a Local Connection without this supporting evidence.

9 8) Other Circumstances 9 Please give details of any other issues you would like us to take into consideration when assessing your application. You may need to include things such as harassment issues or other problems with where you are living now. Please note you must have previously made Colne Housing fully aware of any problem you may be experiencing and all attempts to resolve these problems must have been made before a transfer will be considered. You must also provide supporting evidence from police or other agencies. Declarations Are you related to any member of staff or member of Colne Housing s Board? If yes, please tell us who and your relationship: Have you ever been convicted of a criminal offence? (Declare unspent convictions only) If yes, please tell us the date and nature of the offence: In the last 2 years, have you had any action taken against you for anti-social behaviour? If yes, please tell us the dates, details and outcome:

10 Declarations 10 You should read the following carefully. Please sign to confirm that: The information you have given is correct to the best of your knowledge. You will tell us if your circumstances change or you want to be removed from the list. You give permission for us to use the information you have given to process your application. We will only use this information for this purpose and for statistical reports where you will not be identified. This is in accordance with the Data Protection Act. You give your permission for us to verify the details you have given. You understand that if you deliberately give false or misleading information, you may be disqualified from the transfer list. Furthermore if you are offered housing on this basis, action may be taken to end your tenancy. Signed by applicant 1: Signed by applicant 2: Dated: If someone has helped you complete this form, please give us their details: Please return this form and any supporting evidence to: Colne Housing Digby House Riverside Office Centre Causton Road Colchester Essex CO1 1RJ We will assess your application against our points criteria and let you know whether you have been accepted onto the list and with how many points. If we have not been able to offer you accommodation in twelve months, we will contact you to ask if you want to stay on the list. Please do not hesitate to get in touch with any queries or questions. We will be happy to help.

11 Useful Contacts 11 Colchester Borough Council Rowan House 33 Sheepen Road Colchester CO3 3WG Tendring District Council Town Hall Station Road Clacton CO15 1SE Chelmsford City Council Civic Centre Duke Street Chelmsford CM1 1JE Maldon District Council Princes Road Maldon CM9 5DL Babergh District Council Endeavour House 8 Russell Road Ipswich IP1 2BX Colchester and Tendring Women s Refuge Chelmsford Women s Aid Colchester YMCA Chelmsford YMCA This website is the main way of to apply for council and housing association properties for rent in the local authority areas of Babergh, Braintree, Colchester, Ipswich, Maldon, Mid Suffolk and Suffolk Coastal. Homeswapper is for social housing residents (in rented property) who want to swap their homes known as a mutual exchange (please note: there may be a charge for this service).

12 12 Colne Digby House, Riverside Office Centre, Causton Road, Colchester, Essex CO1 1RJ Tel: Fax: Text Service: Website: Registered with the Tenant Services Authority (L1651) and under the Industrial & Provident Societies Act 1965 (20799R) with exempt charitable status. CHS45 Reviewed January 2018