Section A PERSONAL DETAILS

Title

First name

Last name

Present Address

Postcode

Phone Number

Email

Date moved to this address

اليوم

الشهر

السنة

Do you have a tenancy?

Yes

no

Who referred you to us?

Are you employed?

Yes

No

National Insurance Number

If you are a full time student, state course and college

Section B YOUR HOUSEHOLD

Do you have any additional household member who will be living with you?

Yes

No

Section C PREVIOUS ACCOMODATION

Please give your previous address(es) for the last three years (principal applicant only)

Section D HOUSING NEED

Amenities Do you have the following amenities? Please tick:

Kitchen

No

Yes, for my use

Yes, but shared

Bathroom

No

Yes, for my use

Yes, but shared

Toilet

No

Yes, for my use

Yes, but shared

Bedroom

No

Yes, for my use

Yes, but shared

Living Room

No

Yes, for my use

Yes, but shared

Dining Room

No

Yes, for my use

Yes, but shared

PROPERTY CONDITION/LACK OF AMENITIES:

You may be awarded extra points if your current property is in poor condition or if it lacks basic amenities. Please give details

POTENTIAL HOMELESSNESS

Please tick if you are going to be homeless

Are you currently homeless?

Will you be homeless within 28 days

Are you currently squatting?

Have you received a letter from your landlord asking you to leave

Have you received a court order to leave?

Please describe what kind of difficulties you are currently facing and why you need alternative housing

Are you on any Council Housing Register?

Yes

No

Section E TYPE OF HOUSING

What kind and size of flat or house are you seeking?

Studio/Hostel

1 Bed

2 Bed

3+ Bed

What is your first preference of area? (Please note, we only have properties in Lambeth and Southwark)

Lambeth

Southwark

Do you or any of the people to be rehoused with you have or intend to keep animals?

Yes

No

Are there any medical or other reasons for wanting to move from your present accommodation?

Yes

No

Section F ANY OTHER DETAILS

Please write anything you think we should be aware of:

Section G SIGNATURE

Declaration

I declare that all the information given in this application is correct. I authorise Ash-Shahada to make such enquiries deemed reasonably necessary in order to verify the information I have given and undertake to inform Ash-Shahada of any changes in my circumstances include change of address, persons listed in the application or any other changes which may affect my application.

I hereby consent to Ash-Shahada Housing Association processing my application. I understand that my data will be handled in accordance with the Data Protection Act 2018 and the General Data Protection Regulation (GDPR). I confirm that all the information I have provided is correct to the best of my knowledge.

To the best of your knowledge, are you related to any member of our Management Board or Staff?

Yes

No

Signature

حقل التوقيع فارغ.

Supporting Documents

Please upload your proof of ID (Passport, Driving licence)

Please attach proof of Housing Benefit or Universal Credit (If Applicable)

Please upload any additional documents that could support your application.

Please upload proof of address (Last 3 months bank statement)

Online Housing Application Form

Section A PERSONAL DETAILS

Section B YOUR HOUSEHOLD

Section C PREVIOUS ACCOMODATION

Section D HOUSING NEED

Section E TYPE OF HOUSING

Section F ANY OTHER DETAILS

Section G SIGNATURE

Supporting Documents