Welsh Government Home Improvement Loan Scheme Application Form * Please indicate which local authority you are applying to * Gwynedd Anglesey Conwy Flintshire Wrexham Denbighshire PART ONE ABOUT YOU FIRST APPLICANT 1 Mr/Mrs/Ms/Other please state 2 Full Name as per your passport / driving licence 3 Address 4 Number of years at this address 5 If you have lived at your current address for less than three years, please provide previous address(es) 6 Contact Telephone Numbers 7 E mail address 8 National Insurance Number Date of Birth Home: Mobile: N.I. D.O.B. 9 Please state your current residential status: renting, living with parents/other please specify 10 Are you a current UK resident for tax purposes? If there is only one applicant, please go to Question 22 1
SECOND APPLICANT 11 Mr/Mrs/Ms/Other please state 12 Full Name as per your passport 13 Address 14 Number of years at this address 15 If you have lived at your current address for less than three years, please provide previous address(es) 16 Contact Telephone Numbers 17 18 19 E mail address National Insurance Number Date of Birth Please state your current residential status: renting, living with parents/other please specify 20 Are you a current UK resident for tax purposes? Home: Mobile: N.I. D.O.B. 21 Relationship to First please state 22 Number of dependents / children in the household? PART TWO PROPERTY DETAILS 23 Full Address of Property to be Renovated (including postcode) Postcode: 24 Are you the registered owner of this property? Please note that you must be the registered owner in order to apply for this loan. 25 Is the property freehold or leasehold? Freehold / Leasehold 26 Is the property currently empty? If Yes, how long has it been empty? 2
How many units of accommodation does the property currently provide? 27 28 A unit of accommodation means any self-contained unit which has all the facilities, i.e. bathroom and kitchen behind the main entrance door to the unit. A unit would be a house, maisonette or self-contained flat. How many units of accommodation will be provided on completion of works? 29 What do you intend to do with the property once works have been completed? Live in it (owner occupier) Rent it (Landlord) Sell it 30 How many bedrooms does the property have? 30 Have you applied for any other Council assistance to renovate this property? If Yes, what have you applied for? Will the proposed works require planning permission? If you have answered YES please confirm if planning permission has been: 31 Granted Please include full reference number: Awaiting decision Date Granted: Reference: Date Submitted: Planning permission not yet submitted Will the proposed works require building regulation approval? If you have answered YES please confirm if building regulation approval has been: 32 Granted Please include full reference number: Awaiting decision Date Granted: Reference: Date Submitted: Building regulation not yet submitted 3
PART THREE CURRENT EMPLOYMENT STATUS Please provide the following employment details for each applicant First Second 33 Employment Status, please state employed full/part time, self employed, unemployed, retired, other (specify) 34 What is your occupation? 35 Please state how long have you worked with your current employer 36 Please provide a contact name and address for your current employer. We may contact your employer to verify the information supplied by you regarding your employment. 37 Do you currently use, or have used any pay-day loans? PART FOUR YOUR INCOME DETAILS First Second 38 What is your monthly income? 39 Amount of any benefits you receive per month? 40 Any other income you receive, and how often? Freq: Freq: 41 Your TOTAL monthly INCOME: PART FIVE EXPENDITURE DETAILS 42 Monthly Household Expenses Please tick the relevant expenses box and provide the amount. Both s Mortgage Rent Council Tax Electricity Gas / Oil / Coal Water Rates 4
Home Insurance Telephone Mobile Phone Internet TV Licence Cable / Sky 43 Your TOTAL monthly HOUSEHOLD EXPENSES: 44 Monthly Credit Expenses Please tick the relevant expenses box and provide the amount. Loan / HP Credit Cards Store Cards Catalogue Car Finance Mortgage 45 Your TOTAL monthly CREDIT EXPENSES: 46 Monthly Living Expenses Please tick the relevant expenses box and provide the amount. Food Shopping Clothes / Shoes Public Travel Car Expenses Childcare School Meals Life Insurance Pension 5
Maintenance Lottery Other 47 Your TOTAL monthly LIVING EXPENSES: 48 Monthly Personal Expenses Please tick the relevant expenses box and provide the amount. Cigarettes Alcohol Meals Out Papers Magazines 49 Your TOTAL monthly PERSONAL EXPENSES: PART SIX CREDIT HISTORY First Second 50 Have you ever been refused credit? 51 Have you ever been subject to any CCJ S 52 Have you ever defaulted or missed any credit payments? 53 If YES, when was your most recent default / missed payment? Please note that a credit search will be undertaken on all applicants PART SEVEN RENOVATION WORKS TO PROPERTY Renovation works must be completed within a 12 month period from the date of approval. At the end of the 12 month period, applicants are required to provide the Council with invoices and receipts totalling the loan amount, to evidence the cost of the works. If you experience any problems in completing the project within the 12 month period, you may request an extension to the completion date any requests must be made in writing to the Council, detailing the reasons for the request. 6
Please provide a summary of the intended works, specifying the total costs to undertake these works and clearly stating if this includes or excludes VAT. Please note this application must be accompanied by two fully costed and itemised schedules of work from different contractors. In exceptional cases and where considered appropriate by the Council, a single quote may be acceptable. Please note that you may be eligible to a lower VAT rate depending if and on how long the property has been empty and whether you appoint a VAT registered contractor. Your local Empty Property Officer will be able to provide you with further details Please state how long the project is expected to take to complete: months (works must be complete within 12 months, and can only be extended in agreement with the Council) Description of works Internal External I have included a prepared schedule of works 55 (i) (ii) Have you provided two estimates for the works from different contractors? Name of Company VAT Registered Date of Quote Gross Cost Net Cost 56 Have the extent of these works been agreed with the Council and the costs determined as reasonable for these works? Yes No 57 Have you applied for any Project Management schemes? Yes No 7
58 The following section relates to the property. All applications are subject to a valuation report, unless the property was purchased less than six months prior to this application. The report should confirm current market value and potential value (on completion of the project). The cost of the valuation is included in the administration fee charge. Please note that the Council must be named as an interested party and the surveyor must note that the Council is relying on the valuation report for the purpose of loan application. i. What property is being offered as security? Property being Renovated Other Property If other property please supply the address below: Postcode: ii. iii. iv. If other property - are you the registered owner of this address? When was the property to be renovated purchased? What was the purchase price of the property, including all ancillary costs e.g. legal/surveyor fees, stamp duty etc. Date: What is the value of the property in its current condition? Yes No v. What is the total cost of the works? - This should be the same as question 55 above and include VAT, if applicable. vi. vii. Are there any existing mortgages or loans secured against the property to be renovated? If other property Are there any existing mortgages or loans secured against this property? viii. If you have answered yes to the question above please state the total value of the outstanding loan(s) / mortgage(s) ix. What are the total monthly repayments on the outstanding loan(s) / mortgage(s) x. Who is the current outstanding mortgage(s) with? 8
xi. xii. What is the anticipated total value of the property/units on completion of the works? What is the value of loan you are applying for? (The maximum loan available is 25,000) xiii. What capital funding will you be contributing to the scheme from your own resources? Please note documentary proof will be required to confirm the availability of this funding. (Bank Statement, Mortgage Offer) Have you provided documentary proof? 59 If the total HILS loan does not cover the cost of the works how will you fund this shortfall? Please give details 60 Is there any other information you would like to supply in support of your application? Please give details PART EIGHT DECLARATION Anyone who knowingly makes a false declaration may be guilty of an offence. I / we declare that the information provided is accurate. 1 st Signed: Date: 2 nd Signed: Date: Data Protection The information you give us is confidential and will only be used for purposes of the application for a HILS loan. Where you do provide us with personal information, it will be treated in the strictest confidence, in accordance with the Data Protection Act 1998 (as amended) and we will only use it for the purposes it is given. If we hold information about you, we assure you that we are processing it fairly and lawfully. Using and disclosing information. We will only use or disclose the information about you in accordance with what we have told you, unless we are required to do so for legal reasons. Sharing information with others. Sometimes we have to confirm or share information between organisations. We may pass your information to others who undertake work for us in administering the loan and to prevent fraudulent activity or for debt recovery. If we need to do this, we will make it clear to you on the form you complete giving us the information. For the purpose of the Home Improvement Loan Scheme, information will be shared between the Council and its partners, including for research/evaluation purposes. Publicity If you accept the loan, please tick the box if you do not agree to participate in any publicity campaigns with the partner organisations to promote the initiative. 9