Hafod Housing Association | Housing Application Form

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Applicant 1 Personal Details

Title *

Surname *

First Name(s) *

Date of Birth *

DD/MM/YYYY

National Insurance Number *

Current Address

Date you moved to this address

DD/MM/YYYY

Contact Address (if different from above)

Contact Telephone Number

Are you the tenant of your present home?

Yes No

If YES, please state your Landlord's full name and address and telephone number

Applicant 2 Personal Details

Title

Surname

First Name(s)

Date of Birth

DD/MM/YYYY

National Insurance Number

Current Address

Date you moved to this address

DD/MM/YYYY

Contact Address (if different from above)

Contact Telephone Number

Are you the tenant of your present home?

Yes No

If YES, please state your Landlord's full name and address and telephone number

Further Details

Have you previously made an application to Hafod Housing Association Ltd?

Yes No

Have you or anyone on your application form been convicted of a criminal offence? Not including spent convictions under the Rehabilitation of Offenders Act 1974.

Yes No

If you answered 'Yes' you will be sent an additional form to complete, which will be treated as confidential when returned.

Family Details

List ALL people living at your current address AND those who are not living with you now but who need rehousing with you.

For each please give: Full Name, Male/Female, Date of Birth, Relationship to you, whether this person is living with you now, and whether this person will move with you

Family Details Continued

Do you or any person to be rehoused with you have a physical disability and/or mobility difficulties?

Yes No

Will this affect your/their choice of housing; these could be access needs e.g. a ramp, stair lift or walk-in shower?

Yes No

If you are staying in a hostel or in a house in multiple occupation and you don't know the other residents, please state the number of other occupants.

Are you, or is anyone who wants rehousing with you, expecting a baby?

Yes No

Please provide proof of pregnancy if you indicated 'Yes'

Name of Expectant Mother

Date Baby is due

DD/MM/YYYY

Your Previous Addresses

Please list below the previous addresses (for the past four years) of all the adults included in your application to be rehoused and indicate whether they were council tenants, housing association tenants, owners or other.

For each please give: Full Name, Full Previous Address, Date (from/to), Landlord's Full Name & Address, whether they were an Owner and their Telephone Number.

Question 1

At your current home are you?

Have you ever held a Council or Housing Association Tenancy?

Yes No

If YES, please state Landlord's Name(s) & Address(es)

Question 2

Is your current home?

If other please specify

Number of rooms in property

Please list in order; Double Bedrooms, Single Bedrooms, Bedsits, Living/Dining Rooms

Number of rooms used by you and your family

Please list in order; Double Bedrooms, Single Bedrooms, Bedsits, Living/Dining Rooms

Number of rooms shared with other occupiers

Please list in order; Double Bedrooms, Single Bedrooms, Bedsits, Living/Dining Rooms

Question 3

Shared Facilities - please tick facilities you share with people other than those indicated on the family details section

Kitchen Bathroom Toilet

Question 4

If you live in a flat/maisonette, which floor do you live on?

i.e. ground, first, etc.

Is a lift provided

Yes No

How many steps to the front door?

Question 5

How is your home heated?

i.e. coal fire, full or part central heating, storage heating, if no heating put 'none'

Question 6

Please give details of any major repairs required to your current home

Question 7

Do you have a child/children (not included in you application) to whom you regularly have access? If so please give their detail below.

For each please give: Full Name, Male/Female, Date of Birth, Relationship to You, Current Address, Access Arrangements (i.e. weekends/weekly/holidays/etc.)

Question 8

Do you need a move to:

Give support to a relative Gain support from a relative To secure employment

If any are selected please supply details

Are you making an application under the Move UK (H.O.M.E.S.) Scheme?

Yes No

Are you currently a tenant of Hafod Housing Association?

Yes No

Question 9

Is any member of your household requiring rehousing, seriously ill?

Yes No

Please say who and explain how this effects the type of home you need

Are there any other reasons why you cannot remain in your current property? If so please give details.

Question 10

Do you need to move because your current home does not meet the physical requirements of yourself or any member of your household?

Yes No

If 'Yes' please tick what you need.

Flat Access	Stair Lift	Adapted Kitchen
Ramped Access	Walk-in Shower	All Accommodation on One Level

If other please specify

Question 11

Do you or anyone named in this application have any support needs?

Yes No

If 'Yes' please provide name.

Please indicate which needs as follows and provide documentary/supporting evidence:

Domestic Violence	Leaving Care	Homelessness
Drugs/Alcohol	Mental Health	Learning Difficulties
Young Vulnerable Person

If other please specify

Equal Opportunities Monitoring

Please complete the following to help us monitor the ethnicity of applicants.

How would you descibe yourself?

If other please specify

What languages do you speak?

Do you hold any religious beliefs/faiths that are relevant to your housing and/or support need?

Yes No

If YES, please select one

If other please specify

Declaration

I/we certify that all of the information in this application is correct and understood that if any of it is incorrect or misleading, then this may be grounds for the Association to reject my application or take legal steps to end any Association tenancy granted as a consequence

I/We also also authorise Hafod Housing Association to contact my former landlord(s) or any other relevant person or instituition to verify the information provided in this application or to seek any relevant further information to enable the Association to establish whether I/we will be a fit and suitable tenant and satisfy the Association's eligibility criteria. I/We hereby authorise any such person to release to Hafod Housing Association any documents or information which they may reasonably request.

I/We hereby authorise the National Probation Service or any relevant Social Landlord to disclose all or any of my personal details, whether held on computer under the requirements of the Data Protection Act 1988 or contained in manual records, to relevant organisations in support of my application for housing.

I am aware that this will involve the disclosure of personal confidential information, which is held on computer or manual files.

Tick this box to agree to the above declaration. *

Are you or any joint applicant (if applicable) employed by any organisation within the Hendre Group, or related to a board member or other employee of the Hendre Group?

Yes No

Important; Information given on this form will be treated with the strictest confidence and in line with the Data Protection Act. The Association may wish to supplement the above information with a visit to you at your home and reserve the right to advise other Housing Associations and Local Authorities of any tenancy granted.

Misrepresentation; Any applicant misrepresenting his/her position will not be considered for a tenancy. Any applicant obtaining housing accommodation and subsequently found to have misrepresented his/her position will be dispossessed of the tenancy.

Tonyrefail	Llantrisant	Brynna
Llanharan	Llanharry	Glyncoch (flats only)
Church Village (flats only)	Taff's Well (flats only)	Rhydyfelin

Quakers Yard	Bedlinog (sheltered)	Gurnos
Dowlais

Bridgend	Bridgend (sheltered)	Sarn
Brynmenyn	North Cornelly	Kenfig Hill
Maesteg	Nantyffyllon/Caerau