Online Application For Housing

Title TitleMrMrsMs

First Name

Last Name

Present Address

Date moved to this address

Mobile Number

Email

Telephone

Date of Birth

Do you have a tenancy? Do you have a tenancy? Yes No

If yes what type (e.g. Council, friend's house, rented room)

Who referred you to us?

Are you employed? Are you employed? Yes No

Gross income? (per month)

Net Income (per month)

Occupation

Are you entitled to Housing Benefit? Are you entitled to Housing Benefit? Yes No

National Insurance Number

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

Please give details of everyone (including yourself) for whom accommodation is required and who will live with you (provide surname, first name, date of birth, gender, relationship to you)

If any woman included in this application is pregnant, please give: Name and Expected due date

Do you have any additional household member who will be living with you? Do you have any additional household member who will be living with you? Yes No

Please give your previous address(es) for the last three years (principal applicant only) - Mention address, duration, reason for leaving and tenancy type

If any of the previous are not living with you, please gives names and addresses

Do you have the following amenities? Please tick Do you have the following amenities? Please tick Kitchen Bathroom Toilet Bedroom Living Room Dining Room

Is any of the above amenity shared? Is any of the above amenity shared? Yes No

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

Please tick the shared amenities Please tick the shared amenities Kitchen Bathroom Toilet Bedroom Living Room Dining Room

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

Potential homelessness. Please select any that applies Potential homelessness. Please select any that applies 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? Not applicable

Are you on any Council Housing Register? Are you on any Council Housing Register? Yes No

If yes, state which Council

Reference No.

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

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

Which areas or types of property will you NOT accept?

Do you or any of the people to be rehoused with you have or intend to keep animals? Do you or any of the people to be rehoused with you have or intend to keep animals? Yes No

Do you have any disabilities? Do you have any disabilities? Yes No Prefer not to say

If yes, please provide details below:

Are there any medical or other reasons for wanting to move from your present accommodation? Are there any medical or other reasons for wanting to move from your present accommodation? Yes No

If yes, please state reasons

Please write anything you think we should be aware of

Have you previously been a tenant with Ash-Shahada Housing Association? Have you previously been a tenant with Ash-Shahada Housing Association? Yes No

If yes, please provide the following details: Address of the previous property: Duration of tenancy (start and end dates):

Please provide details for two references. Include their relationship to you, email address, phone number, and physical address.

I declare that all information given in this application is correct. I authorise Ash-Shahada Housing Association to make such enquiries deemed reasonably necessary in order to verify the information I have given and undertake to inform Ash-Shahada Housing Association of any changes in my circumstances include change of address, persons, listed in the application or any other changes which may affect my application. Please select the button below if you agree with the above declaration. I declare that all information given in this application is correct. I authorise Ash-Shahada Housing Association to make such enquiries deemed reasonably necessary in order to verify the information I have given and undertake to inform Ash-Shahada Housing Association of any changes in my circumstances include change of address, persons, listed in the application or any other changes which may affect my application. Please select the button below if you agree with the above declaration. I agree