If you are on our housing register and your circumstances have changed, please fill in
section 1 and every other section where you have a change in your circumstances.
Tamworth Borough Council
Housing Register Application
Change of Circumstances Form
1. Main applicant’s details (You must complete this section)
Your housing application reference number:
(if known)
Title: (eg. Mr/Mrs/Ms/Miss)
Forename:
Surname:
Current address (where you are living now):
Postcode:
Date moved into property:
Previous address (please fill in this box if you
have moved and not told us):
Postcode:
Home telephone number:
Work telephone number:
Mobile:
Email address:
Date of birth:
If you have moved, please provide proof of address for each adult. eg. bank statement,
utility bill.
2. Only complete this section if you are reporting a change of address
Please tell us what sort of home you are living in now (please tick)
House Maisonette – ground floor
Bungalow Maisonette – upper floor
Flat – ground floor Bed sit / room
Flat – upper floor Boat
Caravan/mobile home
Other, please state:
Please tell us about the rooms in the home where you live now.
How many bedrooms do you have?
How would you describe your new housing situation? (please tick one)
An owner occupier Renting from a private landlord
In prison Staying with friends
In Bed & Breakfast accommodation Care leaver
Staying with relatives In a hostel
In hospital In armed forces accommodation
In residential care In tied accommodation (provided with
your job)
Of no fixed address
Other (please state)
If you have a new landlord
please tell us their name and
address:
Postcode:
Telephone number:
* If you are adding another person to your application, please provide proof of identification
(eg. passport, birth certificate or driving license)
Proof of current address
(eg. utility bill, bank statement, dwp document etc)
3. Please list all household members at your current property
If you have moved address, please supply proof of rent account on current property
Rent statement/book
Bank statements showing rent payment to your landlord for the last three months
Reference from your current landlord
First Name Last name Gender Date of
birth
Relationship
to you
To be
housed
with you?
Yes / No
Are they the
tenant or
homeowner?
Yes / No
1
2
3
4
5
6
7
8
4. Only complete this section if you have any other change in
circumstance not mentioned previously.
Please tell us about any other change in circumstance for you or a member of your household
e.g. started a new job, changed a job, a change in health/medical condition/pregnancy and
provide proof:
I/We confirm that the information given in this form is correct and to the best of my/our
knowledge.
I/We understand that any information that is untrue or withheld is a criminal offence under
the Housing Act 1996 and may result in my/our prosecution.
I/We understand that this offence may result in my/our application being removed from the
housing register and/or the loss of any tenancy that may have been given to me/us by the
council or a housing association.
I/We undertake to notify the council of any future change in my/our circumstances as
declared on this form.
I/We authorise Tamworth Borough Council to approach other agencies, such as employers,
benefit agency, credit referencing agencies as well as other council departments to confirm
any details.
Main applicant Joint applicant
Signed:
Date:
Please complete this form and return to us by email:
housingsolutions@tamworth.gov.uk
Alternatively you can print it out, complete and post it back into us at:
Tamworth Borough Council,
Marmion House, Lichfield Street, Tamworth, Staffs, B79 7BZ
If you would like this document in another format (such as large print) or
language, or if you require an interpreter, please contact us on
01827 709709 or email enquiries@tamworth.gov.uk
(01/17) 1822
Declaration:
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