Retirement Application Form

Section A - Applicant Details (Step 1 of 10)

(i.e. house, first floor flat, multi storey etc)

Section A - Household Details (step 2 of 10)

Please give details of everyone living in your current accommodation, starting with yourself.

Section A - Household Details (step 3 of 10)

State below full details of any persons NOT currently residing with you, but wishing to be rehoused with you.

Section A - Previous Accomodation (step 4 of 10)

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

Please start with your current address

Section A - Previous Accomodation (step 5 of 10)

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

Section A - Ethnic Origin of Household (step 6 of 10)

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.

Section B - DETAILS OF PRESENT ACCOMMODATION (step 7 of 10)

(please provide proof i.e. letter from landlord etc)

Section B - TENURE OF PRESENT ACCOMMODATION (step 8 of 10)

Please indicate what best describes your current accommodation by ticking the appropriate box.

Please tick the appropriate box(es) for the size(s) of house for which you wish to be considered.

Section C - MEDICAL AND SOCIAL CONDITIONS
(step 9 of 10)

Declaration (step 10 of 10)

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 theGeneralData 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.