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    Housing Application Form

    Section A: PERSONAL DETAILS

    PLEASE NOTE ALL SECTIONS OF THE APPLICATION FORM MUST BE COMPLETED AND ALL PROOF
    PROVIDED OR YOUR APPLICATION WILL BE NOT BE ACCEPTED AND RETURNED TO YOURSELF


    Household Details

    Please give details of EVERYONE living in your CURRENT accommodation, starting with yourself.

    Your Details


    Person 1

    YesNo

    Person 2

    YesNo

    Person 3

    YesNo

    Person 4

    YesNo

    Person 5

    YesNo

    YesNo

    State below full details of any persons NOT currently residing with you, this will include children to whom you have overnight access, (please provide proof in writing).

    Person 1


    Person 2


    Person 3



    YesNo

    (please attach copy of hospital card showing due date)

    Please list below your present and previous addresses. (last 5 years)

    Please start with your current address

    Current Address



    Address 1



    Address 2



    Address 3



    Address 4



    Address 5



    YesNo
    YesNo

    If yes, please help us to find your application by telling us when the application was made and your name and address at the time.


    YesNo

    Please note:

    (It should be noted that where dogs are permitted, owners have responsibilities regarding fouling and control)

    ETHNIC ORIGIN OF HOUSEHOLD

    It is against the law to discriminate against anyone because of their sex, race, colour or religious beliefs. As an equal opportunity Association, we keep statistical records to ensure that we do not break the law by mistake. If you decide not to answer this question it will not harm your application for housing.

    How would you describe the ethnic origin of your household?

    White ScottishWhite EnglishWhite WelshWhite Northern IrishWhite BritishWhite IrishGypsy/TravellerPolishOther White BackroundAny mixed BackgroundPakistaniIndianBangladeshiChineseOther Asian backgroundAfricanCaribbeanBlackOther Black backgroundArabOther background

    Next

    Section B DETAILS OF PRESENT ACCOMODATION


    Does your accommodation lack any of the following?

    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo

    (please provide proof i.e. letter from landlord or Notice to Quit)

    TENURE OF PRESENT ACCOMMODATION

    CaravanFriends/RelativesImmediate FamilyIn B&B/Temp Accommodation – please provide confirmation from Homeless Case WorkerInstitution i.e. Hospital/PrisonOwner Occupier Reason for leaving and advise date of sale if applicablePartner – Relationship BreakdownRenting Form CouncilRenting Other HA/Co-opRenting Privately - please enclose copy of lease with application formRenting This HARenting With Job – please provide confirmation of employmentRoofless/NFA - please provide confirmation from Homeless Case Worker or DHSSSupported Accommodation - please give us details of support providerOther - please provide details

    SIZE OF HOUSE REQUIRED

    Next

    Section C MEDICAL AND SOCIAL CONDITIONS

    YesNo

    (please provide supporting evidence from your GP)
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    InsideOutside
    YesNo
    YesNo

    YesNo

    YesNo

    Next


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    We realise that this application form is long and goes into some detail. All information given to us will be treated in confidence. If you have any difficulty in filling in this form then our Customer Services staff will help.

    Finally, please read carefully the declaration below.

    I/We understand that the information contained in this Application Form will be stored in a computer system by Parkhead Housing Association. I/We give my/our consent to the processing of this personal data (including any sensitive personal data) in this Waiting List Application Form. I/We understand that, under the General Data Protection regulations, I/we have the right to examine this data and amend it if it is incorrect.

    I hereby declare that the information which I have provided on this application for Housing is correct. I undertake to advise Parkhead Housing Association Limited of any changes in the circumstances of myself or my household which may affect my application. I understand that if I knowingly or recklessly make any false or misleading statement or withhold any relevant information which induces the Association to grant a tenancy to me then the Association may recover possession of that tenancy.

    I authorise my current or any previous landlord to provide information to Parkhead Housing Association Ltd relating to the conduct of any tenancy held by me.


    Applicant Checklist

    Have you provided the following:

    Utility Bill orBank Statement orIncome Support Letter orDWP Letter
    Birth Certificate orChild Benefit Letter or Child Tax Credit orDSS Letter orBank Statement
    Letter from doctorCPNSocial WorkHospital
    Wage Slip orIncome Support Letter orDWP Letter/Child Tax Credit orNational Insurance Card
    Copy of an up to date missive orNotice to Quit
    Wage Slip orProof of Income/Benefits orBank Statement

    PLEASE NOTE ALL INFORMATION MUST BE PROVIDED OR YOUR APPLICATION WILL NOT BE ACCEPTED