Fillable Housing Application Form (Redditch Borough Council)

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Housing Application Form (Redditch Borough Council)

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Housing Application Form
Please tick the relevant boxes and complete the form using BLOCK CAPITALS in BLACK INK
This form will only be registered if completed fully
1. Personal details
Applicant (yourself)
Joint Applicant/Partner
Title (e.g. Mr/Mrs/Ms/Miss/Other)
First name and middle name (if applicable)
Surname
Date of birth (DD/MM/YYYY)
Relationship to the applicant
(joint
applicant only)
Not applicable
National Insurance Number
Nationality
Have you or any household members to be
re-housed with you come from abroad tolive in
this country within the last 5 years?
Yes  No
Yes  No
Are you subject to Immigration Control? If you are
unsure please check with UK Visa and
Immigration on
0300 123 2253
Yes  No
Yes  No
Current Address line 1 - House name/number
Current Address line 2 - Street name
Current Address line 3
Current Address line 4 - City/Town
Current Address line 5 - County
Current Postcode
What date did you move into the property?
Are you the owner/tenant of this property? If not
please state who is e.g. Parent/Friend
Current Contact Telephone Home
Current Contact Telephone Mobile
Email Address
If you receive support from a professional, family
member or friend eg: Probation Officer, Support
Worker, Social Services, please provide their
name and telephone number
Are you/or your partner pregnant?
When is the baby due? (Please provide proof)
Office use only
Date received:
Registration number:
2. Details of other household members to be housed with Applicant
(if there are more than 5 other members please
write all details in Section 15)Please donotinclude Applicant or Joint Applicant/Partnersdetails.
Title
First name
Date of Birth
Relationship to applicant
3. Please list all the previous addresses where you have lived in the last five years
Applicant’s addresses – including
postcodes
Date from
Date to
Landlord/owner name
and contact details
Reason for leaving
Joint Applicant/partner’s addresses
– including postcodes
Date from
Date to
Landlord/owner name
and contact details
Reason for leaving
4. Other Local Connections
Please state any close adult family
connections
youmay have to Redditch e.g. parent, adult
sister or brother or adult child
Details:
pleasegive
fullnames,addresses and relationship
of close
relatives and approximately how long they have lived there(furtherdetails
canbeprovided atSection15)
Relatives
Other
Are there any areas in Redditch that would
be unsuitable for you to live in?
If yes, where and why:
5. Economic status
(please tick)
Applicant
Employed
0–15hoursperweek
16–23hoursperweek
24 hoursper week – full time
Jobseeker
In education/training
Retired
Unable to
work
Joint
Applicant
/partner
Employed
0–15hoursperweek
16–23hoursperweek
24 hoursper week – full time
Jobseeker
In education/training
Retired
Unable to
work
6. Employment details
Applicant
Name of employer ...............................................................................................
Date employment commenced:
Address of work place ........................................................................................................................................................
..................................................................................................................................................................................................
Ifyou are self-employed, please provide details of type of and locationofemployment
Date self-employment commenced:
Joint
Applicant/
partner
Name of employer ...............................................................................................
Date employment commenced:
Address of work place ........................................................................................................................................................
..................................................................................................................................................................................................
Ifyou are self-employed, please provide details of type of and locationofemployment
Date self-employment commenced:
7. Household income
(including benefits)
Are you in receipt of any of the following income based benefits?
Applicant
Joint Applicant/partner
JobSeekersAllowance
Income Support
Employment and Support Allowance
Pension Credit Guarantee
WorkingTax Credit
Child Tax Credit
UniversalCredit
If employed, what is your total gross household income (including all other benefits) per year?
£0– £9,999 
£30,000– £34,999
£10,000– £19,999

Morethan£45,000
£20,000– £29,999
Applicant Joint Applicant
Do
you,
either on your own or jointly,
have
savings/ or equity in a property
above
£95,000
Yes
Yes

If you have any debts fromloans or credit cards, please give details of the amount and type
8. Other information
Please answer all questions in this section – If Yes please
provide evidence
Applicant
Joint applicant/partner
Are you a Key Worker in the Borough? e.g. NHS staff,
teachers, police officers and some civilian staff in the
police force, prison and probation staff, social worker,
education psychologists, planners and occupational
therapists employed by the local authority, fire fighters
and retained fire fighters.
Start Date
Yes
No

Yes
No

Do you volunteer for a minimum of 20 hours per
month?
Start Date
Yes
No
Yes
No
Are you a full time carer in receipt of Carer’s
Allowance?
Start Date
Yes
No
Yes
No

Do you haveaseveredisability and areinreceiptofahighrate
disability benefit?
Please provide proof of benefit and what rate.
Start Date
Yes
No

Yes
No
9. Housing information
Please answer all questions in this section
Applicant
Joint applicant/partner
Has there been or is there currently any legal action for anti-
social
behaviour being taken against
you or any
memberof
your household or anyone who is going to be housed with you?
Yes
No
If ‘Yes’ please provide details here:
Have you currently/previously breached your tenancy agreement for
poor property condition?
Yes
No
Yes
No
If ‘Yes’ please provide details here:
Have you currently/previously breached your tenancy agreement for
any other reason?
Yes
No
Yes
No
If ‘Yes’ please provide details here:
Have you ever been evicted for rent arrears, anti-social behaviour
or any other reason?
Yes
No
Yes
No
Doyouhaveanyhousingrelateddebt?(e.g.rentarrearstoa
private
landlord or letting agent; debts owed to a Council or
housing
association, including former tenancy arrears; mortgage
arrears; Housing Benefit overpayment or Council Tax debts).
Yes
No
Yes
No
If ‘Yes’ please provide details here:
Are
you or any
member of your household or anyone who is going
to be housed with you required to register with the Police under the
terms of the Sexual Offences Act 2003? (e.g. sexual assault,
sexual activity without consent, child sex offences).
Yes
No
If ‘Yes’ please provide details here:
10. What is your current housing?
Applicant
Joint applicant/partner
Do you own the home where you live?
Yes
No
Yes
No
Doyouhaveafinancialinterestin anyotherproperty– UK or abroad?
Yes
No
Yes
No
Do you rent your home from a private landlord?
Yes
No
Yes
No
Do you rent your home from a Housing Association or any Council?
Yes
No
Yes
No
If you have a landlord (any type),pleaseprovide:
Name:
Address:
Telephone:
Areyou
Living in tied accommodation
Yes
No
Yes
No
Living with parents, other family or friends
Yes
No
Yes
No
Sharing or lodging
Yes
No
Yes
No
Due to leave hospital, care, prison or other institution?
Yes
No
Yes
No
What type ofpropertydo you live in?
(House/Flat/Bungalow/Bedsit/Studio/Maisonette)
(Please state
what floor if you live in a flat/studioe.g.groundfloor, first floor, second
floor)
How many bedrooms are in your current home?
Please give detail of any pets you have:
Property Details – Please give the number of rooms in your property and indicate whether
you/your household has exclusive use
Facilities
Total Number of
Rooms
Shared Use
Exclusive Use
Living Room
Kitchen
Bathroom
Separate Toilet (not included in
bathroom)
Bedrooms
Other (please state)
Use of Bedrooms: Please include everyone living at this address and indicate whether they will be
rehoused with you
Double
Single
Name(s) of People/Person Using
this Room
Age
To be Rehoused?
Y/N
Bedroom 1
Bedroom 2
Bedroom 3
Bedroom 4
Other (please
state)
11. Housing circumstances
– please tick if the statement applies to you
Are you homeless or threatened with homelessness?
Please explain at section 15
Is your property in disrepair?
Please explain at section 15
Do you oryour family member need to movebecauseofa medical
or disability need?
Please explain at section 15
Doesyourpropertyhaveaidsandadaptationswhichyounolongerneed?
Please explain at section 15
Is your current property too big for you?
Please complete the overcrowding/under
occupier form at section 14
Have you received a Notice to Quit or Repossession Notice?
If yes please provide a copy, along with your tenancy agreement
Please explain at section 15
Are you experiencing harassment or violence?
Please explain at section 15
Do you consider yourself to be overcrowded?
Please complete the overcrowding/under
occupier form at section 14
Do you have another reason for needing to move?
Please explain at section 15
Applicant
Joint applicant/partner
Do you require housing with support?
Yes No
Yes No
Do you need older person’s housing?
Yes No
Yes No
Are you interested in or do you need Extra Care older person housing?
Yes No
Yes No
HaveyouortheJointApplicant everservedinthearmed
forces? Ifyou haveservedwhatwasyourdischargedate?
Are you, or have you been, a spouse or civil partner of a
member of the armed forces?
Yes No
Yes No
Are you a Care Leaver?
Yes No
Yes No
If yes what date did you leave Care?
12. Would you be interested in shared ownership or other
help to buy schemes? For more information go to
www.helptobuy.gov.uk
Yes No
13. If you are an existing Housing Association/Council
tenant wouldyou beinterested in a mutual exchange
where, with the permission of your landlord, you swap
your home with another tenant? For more information go
to www.homeswapper.co.uk
Yes No
14.OvercrowdingorUnderOccupyingForm
–Pleasecomplete the table belowwith details of all the people who
livein the property with you, even if you do not wish them to move with you. (Do not include applicant and joint
applicant)
Number of bedrooms at the property:
Doubles:
Singles:
Full name
Sex: Male/Female
Date of birth
Relationship (To main applicant/joint applicant)
15. Please provide any other information relating to why you would like to be rehoused:
16. Are you or a member of your household an employee of the Council or a Council owned company or
other arms-length service e.g. Rubicon Leisure Limited, or related to any Council/ Housing Association
Staff or Local Councilor/Housing Association Board Member
?
Staff member includes anyone employed by a Council
owned company e.g. Rubicon Leisure Limited, Elected Members, or close relatives of either. Close relatives means mother,
father, sister, brother or adult child (aged 18 and over), aunts, uncles and grandparents.
Yes No
If yes, please give their details:
17. Has this form been filled in by someone other than the person(s) making the application?
The person who has filled in the form (the representative) must fill in this part
Are you an officer of the Council/Housing Association?
Yes No
Name:
Relationship to Applicant:
Address:
Contact number:
Date:
18. Privacy Statement
Why do we collect this information?
We need the personal information you supply so that we can check whether you are eligible to be housed
by the Council or registered providers. The legal basis for this processing is legal obligation under the
Council’s public task as set out in part 6 and part 7 of the Housing Act 1996 as amended.
What information is collected?
Name
Address
Family details
Financial circumstances
Employment details
Housing circumstances
Health details
Who has access to the information?
This information will be accessible by the staff working in Housing Services. It is usually shared with social
landlords so that they can allocate their properties as appropriate. The information may be shared with
many organisations, for example; other local authority departments, medical practitioners and advisers,
UK Government departments and agencies.
Please note that if you want to use our housing allocation service, we must be free to contact other
organisations, to share your information with them, and to ask for information from them. For this reason
you cannot specify which organisations you are happy for us to contact.
Is the information sent outside the EEA?
This information will not be transferred outside of the EEA.
How long is the information kept?
The information will be kept for six years from the closure of your application. An application is considered
closed after:
you have been allocated a property, or
your application has been inactive for one year, or
you have asked for your application to be closed
Are any automated decisions made using this information?
No decisions around this information are made by automated means.
Your rights
Your statutory rights and other privacy information is available on the Redditch Borough Council website:
https://www.redditchbc.gov.uk/council/corporate/your-access-to-information/privacy-notice.aspx
Please tick to confirm these details are correct
19. Your declaration
I/we confirm that the information given in this application form is true and correct. I/we will inform Redditch Borough
Council immediately of any change in my/our circumstances. I/we understand that this Application Form will be
cancelled if I/we have given false information. I/we understand that if I have provided false or misleading information
or withheld information required by the Council to perform its duties is an offence under 171 Housing Act 1996. I/we
understand that this application may be cancelled if I/we fail to notify a change of circumstances.
I/we understand that Council and Housing Association Landlords are entitled by law, to take action to withdraw an
offer of a tenancy and terminate any tenancy obtained by deception.
Applicant’sname .....................................................................................................................
Joint applicant/partner’sname ..................................................................................................
I give permissionthat ........................................................................................................................... canactonmybehalf
(name/organisation)
Applicant name .........................................................................................................................
In order for the Council to process and verify your application for each adult on the application you must provide
2 proofs of current residency. One of these must be dated within 3 months of your application and not already
from Redditch Borough Council and you also need to provide 1 form of identification.
Proof of Residency
Tick
Form of Identification
Tick
Recent Bank Statement
Birth Certificate
Confirmation of Any State Benefits
Driving Licence
Life Assurance/Insurance Policies
Current and Valid Passport
Letter from Solicitor or Inland Revenue
Marriage Certificate
Utility Bill – gas/electric/water/telephone/mobile
For each child on the application form you must provide a copy of:
Birth certificate or current valid passport
Child Benefit or Tax Credit Letter or screen
shot of Universal Credit Journal showing the
breakdown of benefits including any child
element.
The Council will not accept responsibility for original documents. Photocopies, photographs and screenshots
will be acceptable where they are of sufficient quality to confirm the identity of the relevant household member.
Your application will be sent back to you if you have not provided all the documents necessary to process your
application.
If you are unable to provide any of this evidence, please contact the Council so that we can consider other
means of verification.
Please attach your completed form in an email to housingoptions@bromsgroveandredditch.gov.uk
Date:
Date:
Date:
Please tick this box to agree to the declaration and fill in your details below
20. Equal Opportunities (optional)
All the information you provide will be treated as confidential, and we will only use it for equal opportunities monitoring. If
you do not want toanswer certain questions in the following sections, leave blank. Please tick appropriate box for both
youandyourjointapplicant/partner.
Ethnic Origin
Applicant
Joint applicant/partner
White: British
White: Irish
White: other
Mixed: White and Black Caribbean
Mixed: White and Black African
Mixed: White and Asian
Mixed: other
Asian/Asian British: Indian
Asian/Asian British: Pakistani
Asian/Asian British: Bangladeshi
Asian/Asian British: other
Black or Black British: Caribbean
Black or Black British: African
Black or Black British: other
Chinese
Gypsy/Romany
Traveller
Other ethnic background
Prefer not to say
What is your religion?
Applicant
Joint applicant/partner
None
Christian
Hindu
Jewish
Muslim
Sikh
Other
Prefer not to say
Sexuality
Applicant
Joint applicant/partner
Heterosexual
Gay or Lesbian
Bisexual
Prefer not to say
Other
What Gender do you identify as?
Do you consider yourself to have a disability?
Tick if yes
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Housing Application Form (Redditch Borough Council)

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Completed 20 January 2021

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