Please answer all the questions on this form. We may need further information to support your
application. Please refer to the checklist at the end of this form for further guidance. Please be
aware that if you fail to provide any of the relevant information or provide us with misleading or
false information, your application may be disqualified or it may not be awarded the correct priority.
If you need help completing this form, please contact the Homefinder Service on 01942 486182 or
01942 486183.
Office Use Ref Number
Housing Application
Main Applicant
1: Your Details
a Joint Applicant (if applicable)
Title (please tick)
Mr Miss Mrs Ms Mr Miss Mrs Ms
First Names(s)
Previous Surname
or Alias
Date of Birth
Male Female Male Female
National Insurance
Passport Number
b. Please list below your current address
Main Applicant Joint Applicant (if applicable)
Change of Address Form
Age Age
c. If you do not want letters going to your home address or you are of no fixed abode, please provide a
contact address where we can write to you. This can include friends, family, support workers, etc.
d. What are your contact details? Please remember you MUST provide us with up to date contact
details and tell us if you change the details as you could miss out on an offer of accommodation in
the future.
Main Applicant Joint Applicant (if applicable)
Daytime telephone
Work telephone
Mobile telephone
Email address
e. Please list below everyone living in the property. Proof will be required for any children under 16 on
your application who will be moving with you. If you are living in 2 separate properties, please give
details for the main applicant.
Title Last Name First Name(s) Date of
Age Relationship
to You
Will they be
moving with you
f. Is anybody moving with you pregnant?
Expectant mother’s name
Expected date of birth
g. If you do not currently live in the Borough, please detail below why you wish to move into it. For example,
you are employed in the Borough or wish to give or receive support from family members. Please provide
details of your connection to the Borough – location of work; addresses of family members etc.
Yes No
2: About Your Housing Circumstances
a) Do you or anyone who will be moving with you suffer from
a chronic illness or permanent disability?
Yes No
Please describe the illness/disability
Name of person with illness/disability
b) Does the person use a wheelchair?
Yes No
c) Is your current property adapted? If yes,
please give details of the adaptations below
Yes No
d) Are the adaptations still needed? If yes,
please explain why below
Yes No
If you have answered yes to this question we will send you an application for Medical Priority to enable us to
assess your application on medical grounds.
e) Do you require an adapted property? If yes, please list
the adaptations you require.
Yes No
Please be aware that we cannot always guarantee that adaptations can be provided.
* If you cannot return to your home when discharged, please explain why at question 5e
g) If you or your partner are living in accommodation provided by the
Armed Forces, did you live in the Wigan borough before enlisting?
Yes No
If yes, please provide details of your last permanent address before enlisting in HM Forces. Please
provide dates.
f) Are you currently: (please tick one)
Renting from Wigan Council
Renting from another Council
Renting from a Housing Association
Renting from a Private Landlord
An Owner Occupier
Living in Supported Accommodation
In accommodation provided by HM
Living with Parents
Lodging with Others
Of No Fixed Abode (please provide a
correspondence address at Q1c)
Living in Bed & Breakfast/Hotel
In Hospital or Short Term Residential
Care *
Living in Prison
Living in Hostel without Support
Other (please state in box on the right)
Are you a former member of the Armed Forces or a reservist
with the Armed Forces?
Yes No
Yes No
h) Does your family live in two separate properties because there is no
suitable accommodation available for you all to be together?
If yes, please explain why you have to live apart at question 5e
i) Are you leaving local authority care?
Yes No
j) Do you own your property or have owned a property in the last
12 months?
Yes No
How much did you receive or do you expect to receive when your
home is sold?
If you received or expect to receive less than £65,000 when the property is sold, we will need
evidence of this otherwise your application may not be awarded the correct priority.
k) Are you likely to lose your accommodation?
(If yes, please explain why at question 5e)
l) Do you have to leave your home due to domestic violence?
m) Do you have to leave your home due to a Compulsory Purchase
Order or because it is going to be demolished?
n) Are you in accommodation lacking normal facilities such as for
washing, cooking, etc. or is the property in a dangerous or
otherwise poor condition?
o) Are you a potential adopter, a foster carer or Supported Lodgings host
and need to move to accommodate children or young people?
p) What type of property are you living in now?
No Fixed Abode
Sheltered Housing
Other (please state)
Yes No
Yes No
Yes No
Yes No
Yes No
q) How many bedrooms are there, in total, in the property that you are living in?
r) If you live in a flat, bedsit or sheltered accommodation, which floor is it on?
Ground Floor First Floor Second Floor or Above
s) If you live in a flat, does it have a communal entrance?
t) Is there a lift in the building?
u) If you live in a bedsit, do you have regular overnight access
to any children?
Yes No
Yes No
Yes No
e) Is there anything else you think that we should know to help us assess your application? If so
please give us details below. It is important that you give as much information as possible.
Declaration And Authority To Obtain Details From
Another Agency
Signing the declaration below means that you agree to the terms and conditions listed in sections 1 and 2.
All information provided by either yourself or a third party will be used for the sole purpose of enabling
Wigan Council to assess your application for housing in accordance with the Council’s Allocation Policy and
the Data Protection Act 1998.
Section 1.
I understand that Wigan Council will decide whether to give me a tenancy based on the information that I
have given on this form. The information that I have given is true and correct to the best of my knowledge. I
understand that if I give false or misleading information or do not provide relevant information, Wigan
Council may exclude me from the Housing Register. This means I will not be allowed a Wigan Council
I understand that Wigan Council, or any partner agency such as a Housing Association, can take back any
tenancy they have given me if I have provided false information. I will tell Wigan Council if my
circumstances change.
I understand that I may need to provide two satisfactory references as part of this application. I give my
permission for Wigan Council to contact any person who has given me a reference to confirm the
details given.
Section 2.
I understand that Wigan Council may need to contact other agencies for information about me so they can
process my application and assess my suitability to be a tenant and abide by the conditions of tenancy. This
could include contacting Housing Benefits and Council Tax, other landlords, the Benefits Agency, Probation
Service, the Police and Social Services.
I give permission for Wigan Council to undertake identification verification and/or credit checks with an
external company to confirm my identity and help establish that I am able to afford the outgoings to manage
a tenancy.
I give permission for Wigan Council to contact any relevant agencies, including my present and/or former
landlord. I give these agencies permission to share any information they hold on me with Wigan Council so
that they can deal with my housing application and any future tenancy. I understand that even if I do not
agree to allow this, some information can still be shared to prevent and detect fraud or if it is to stop me
committing crime.
Your Signature Date
If you are returning the form electronically, do you agree to the points in the declaration above?
Yes No
Joint Applicant Signature
Please note: Your change of address form will not be accepted if you fail to sign this declaration. Please
contact Wigan or Leigh Life Centre or the Homefinder Service if you wish to discuss this further.
Please tick to show that you have sent us all the relevant information we need to register your
Main Applicant Joint Applicant Does not
Proof of a local connection if you live outside
of the Wigan Borough or have lived in the
Borough for less than 5 years
2j An estate agents valuation and details of any
outstanding mortgage if your equity is below
£65,000 or details of the equity you received if
the property has been sold or repossessed.
2m Evidence of Compulsory Purchase Order or
proof that the property is going to be
2n Evidence from Environmental Services
confirming that it is not reasonable for you to
continue to live in the property long term.
2o Evidence to show that you have been
accepted to adopt a child or as a foster carer
or supported lodgings host.
Application Form checked by:
Contact Details
Wigan Council
Leigh Life Centre
Turnpike Centre
Civic Square
Telephone 01942 486182 / 486183
Wigan Council
Wigan Life Centre
The Wiend
Telephone 01942 486182 / 486183
This receipt is to confirm that Wigan Council have received your completed change of address
application form on the below date.
Date Stamp