Application for Housing

Transcription

1 Application for Housing Name(s): / Address: Postcode: Telephone No.: (Home) (Work) Mobile(s).: / Mailing Address: Only to be completed if different from address above.please note, if this section is completed all mail relating to your application will be sent to the mailing address. Ref. No. Issued Re turned Angus Housing Association Limited 93 High Street Arbroath Angus DD11 1DP Tel Fax The Square Ormiston Crescent Dundee DD4 0UD Tel Fax Angus Housing Association is a registered Scottish Charity SCO20981 Property Factor Registered No. PF000129

2 1. INTRODUCTION Angus Housing Association Limited is a charitable organisation run by a Committee of Management made up entirely of voluntary members. At present we have around 1,800 houses in management, mainly in Angus. We do however, have over 400 houses in Dundee. Although our housing varies in type, size and location, we are unable to provide housing for households with more than 8 persons, therefore, anyone who has a household above this size need not apply. Please note when completing this Application Form that our houses are allocated according to need and points and will be awarded according to your present circumstances. We already deal with large numbers of enquiries and cannot guarantee you a house. When we have assessed your application, we will contact you to advise you of how many points you have been awarded. If you would like a copy of our Allocations and Transfers Policies and Procedures, they are available, free of charge, from the Association s offices. In the meantime, if you have any enquiries on any aspect of your application, please contact the appropriate office. Angus Housing Association Limited The Square 93 High Street, Arbroath Ormiston Crescent, Dundee Angus, DD11 1DP DD4 0UD Tel No Tel No COMPLETING THIS FORM Please read each section of the form carefully before filling it in. Please note that we are unable to process incomplete applications. The more information you give us, the easier it will be for us to make sure you get all the points you are entitled to. If you need help filling out the form, just ask our staff. Applicants should note that information given on this form will be held on a computer file within the guidelines laid down by the 1998 Data Protection Act. The Association is registered in accordance with this Act with the Data Protection Register. Finally, you should note that the Association reserves the right to contact whoever it believes to be necessary to check the accuracy of the details you provide. All the details you give will be treated in the strictest confidence.

3 3. PERSONAL DETAILS 3.1 How would you describe yourself (please tick the appropriate box). Single Married Divorced Civil Partnership Separated Living with Someone Widowed 3.2 If you DO NOT have a British Passport please complete the section below. Title Name Country of Birth Date of Arrival in Country Residency Status TENANT JOINT TENANT 3.3 If you were offered a house by the Association, please state the names and other details of the people WHO WOULD BE STAYING WITH YOU by filling in the box below. Please put your own name first in the box marked APPLICANT. Name Address Sex M/F Relationship to you APPLICANT DOB Occupation National Insurance No for all over 16 years Disability Yes/No Ethnic Origin

4 3.4 Please list the last four addresses you have lived at before your present address within the last 5 years in the box below. Do not write your present address in this section, put your most recent address in the top line of the box and your three previous addresses below. Do not worry about the exact dates. Information to the nearest month is acceptable. WE CANNOT ASSESS YOUR APPLICATION IF YOU DO NOT COMPLETE THIS SECTION. Address From To Name and Full Address of Landlord/Owner Were you the tenant at this address Reason for Leaving Partners previous addresses (if joint application) Address From To Name and Full Address of Landlord/Owner Were you the tenant at this address Reason for Leaving

5 4. YOUR PRESENT HOUSING CIRCUMSTANCES This section of the form contains the questions about your present housing circumstances. Your answers help us to award points according to your housing need. Please complete this section as fully and accurately as possible. 4.1 In the house you are currently living in, are you; Tenant Joint Tenant Sub-tenant or Lodger Living with Friends or Relatives Owner Occupier If you are living between friends/family, please fully complete section 4 giving details of the address you stay at most nights during the week. If other please give details: 4.2 How long have you stayed in your present house? Years Months 4.3 Who owns or is the landlord of your present address. If you are renting privately from a private landlord we will require a copy of your Lease Agreement and any Notice to Quit you may have received. Name: Address: Telephone No. (if known) 4.4 If you are a joint tenant or owner of the house you presently live in, please give names of the other joint tenant/owners Name: Name: 4.5 What type of house do you presently live in: Tenement Flat Maisonette Cottage Multi Storey 4 in a Block Caravan/Mobile Home 4.6 Location of House: Ground Floor 1 up etc. PLEASE STATE LEVEL 4.7 Number of bedrooms in present house: Single Double

6 4.8 How many people, INCLUDING YOURSELF, live in the house? Please give details below of their age, sex and relationship to you. This box is very important as it helps us to decide if you are overcrowded or not. Is anyone pregnant? YES NO Their name Due Date Name Relationship to you Age Sex Date of Birth Who sleeps where? Bedroom Name Other 4.9 Does your house have the following facilities Running Hot Water YES NO An Inside Toilet YES NO A Bath or Shower YES NO 4.10 In your present house, do you have to share any of the following rooms with other people or families Living Room YES NO Kitchen YES NO Bathroom YES NO Bedroom YES NO

7 4.11 Does your present accommodation have double glazing YES NO Does your present accommodation have central heating YES NO Has your property been classified by Below Tolerable Standard by the Environmental Health Department or does it suffer from extreme dampness YES NO If YES, please give details: 4.12 Please tell us the reason(s) you wish to be rehoused (continue overeaf)

8 4.13 Do you have any pets? YES NO If YES, please give details: 5. YOU AND THE ASSOCIATION In assessing your application, we are interested to find out why you are seeking Association housing. To do this, we would be pleased if you could answer the following questions. 5.1 How did you find out about the Association? 5.2 Have you applied to the Association before? 5.3 Are you, or any member of your family, a relative of or has a connection with, any member of staff or of the Committee of Management of Angus Housing Association Limited? YES NO If YES, please state their name and relationship to you. Name Relationship

9 6. WHAT TYPE OF HOUSE DO YOU WANT This section is about the type of house you want, please try to give as much information as possible. Remember that if you are only willing to consider certain types of houses, it may take longer to get an allocation as they may be popular or in short supply. 6.1 What type of house do you want? Maisonette (flat with Internal Stairs) Flat Bedsit Bungalow House No Preference 6.2 What size of house would you like? (please read the following) The Associations Allocation Policy states that children of the opposite sex should have their own bedroom at the age of 5. Same sex children require their own bedroom at 12 years of age. Welfare benefits have changed. How much of your rent is covered by the Housing Costs part of any benefit you get will depend on your circumstances. For example if you are allocated a house which the government decides is bigger than you need, this is likely to affect the amount of benefit you get and you will have to pay the difference. You can find out how the rules might affect you by contacting us at any of our offices. Please note that under no circumstances will the Association allocate a property to a household of a larger number than the house is designed for. How many bedrooms would you like to be considered for? 6.3 Do you want to apply for Sheltered Housing? (available in Arbroath only) YES NO If YES, in which area do you wish to be housed? Russell Square Abbot Street 6.4 If you are applying for Sheltered Housing do you also want to be considered for mainstream housing? YES NO Have you applied to Angus Council or Dundee City Council for Sheltered Housing? YES NO 6.5 What type of heating would you prefer? Gas Electric No Preference 6.6 Do you want a garden? YES NO Shared No Preference 6.7 What floor do you want to live on? Ground Floor One Stair Up Two Stairs Up Three Stairs Up Four Stairs Up No Preference 6.8 In which areas do you wish to be housed? (see map on back of form) Airlie Arbroath Auchmithie Brechin Carnoustie Dykehead Ferryden Forfar Friockheim Gowanbank Hillside Inverkeilor Kirriemuir Letham Montrose Dundee area: Barnhill Kirkton Road Mid Craigie Whitfield

10 7. SPECIAL REASONS FOR HOUSING If someone has special reasons for need of a house because they either a) have employment or the offer of employment b) need to be close to relatives for medical reasons, or c) have other reasons If you are in this situation you MUST fill in this section. 7.1 If you want to move to Angus or Dundee for employment reasons, please give below the name and address of your employer. Name Address 7.2 If you want to move to be near relatives, please give the name and address of the relatives and the reason you need to live close to them Name Address Reason

11 8. SPECIAL NEEDS, MEDICAL CONDITIONS AND DISABILITIES 8.1 Do you or any member of your household have any special housing need because of health and medical conditions? (Please read the enclosed leaflet, which explains when priority medical points will be given.) YES NO If yes, you will be issued with a Special Needs and Medical Assessment Form, which you must complete in full and return to the Association. Once this is received it will be forwarded to the Independent Medical Assessor for Tayside who will determine any priority which should be given for rehousing. The decision made by the Medical Assessor will be final and staff will accept the assessment. If you have previously completed a form, and your circumstances remain the same, please tell us which Housing Association or Local Authority this was for and for which member of your family the medical applies to. 8.2 Does anyone who intends to live with you use either a Wheelchair Walking Frame 8.3 Would you require any of the following adaptations if you were housed by the Association? Level Access Grab Rails Rampable Access Stair Lift Walk In Shower Wet Room Other please state If YES, please list Which member of your household needs the adaptations? 9. ANYONE WHO SUPPORTS YOU If you currently have a Support Worker, Carer or family member who helps you or acts on your behalf and would like them to help you in the future when we contact you, please give us their name and contact details (including their phone number). Please ask their permission before giving us their details Name Home Ph No Address Mobile Relationship to you What type of support do they give you? Do you think that you or the joint applicant may need support to maintain a tenancy? YES NO

12 10. KEEPING IN TOUCH In order that we do not lose contact with you after you have completed this form, it is important that you inform us of any changes in your circumstances, especially if you change address or telephone number. Failure to respond to any correspondence from the Association will mean you risk your application being cancelled automatically. 11. REVIEWING YOUR APPLICATION We will usually contact you every 6 months to ask if you wish to remain on our waiting list. If you do not reply your application may be cancelled. 12. OTHER INFORMATION If there is any other relevant information which you want to give, please use the space below to provide it. 13. PROOF OF IDENTITY We require Proof of Identification for everyone included in Section 3.3 of this form. You must provide us with copies of two items from the following list for each adult aged over 16 and one proof of ID for each child. Birth certificate Passport l Driving licence Marriage certificate National Insurance card Medical card UK Residence Permit EC/EEA Identity card Current gas or electricity bill Letter from a solicitor/social worker/probation officer /HMRC/Home Office/Department of Work and Pensions/H.M.Ps

13 14. DECLARATION 14.1 I understand that providing false, inaccurate or misleading information will lead to my application being cancelled Has anyone included on this application been evicted for anti-social behaviour within the last 3 years? YES NO If yes, please provide details below. Name of Person Evicted Evicting Landlord 14.3 Has any person covered by this application been the subject of an Anti-Social Behaviour Order (ASBO) under Section 19 of the Crime and Disorder Act 1998, on or after 30th September 2002? YES NO If YES please provide details. Name of person subject to ASBO: 14.4 Are you, or any person noted on this application form required to register with police under the Sex Offenders Act 1997 YES NO 14.5 Please sign the following declaration:- I declare that to the best of my knowledge, the answers given to the questions on this application are true and accurate. I/We understand that any false information provided may result in my/our application being cancelled, or if I/we are rehoused by the Association, may result in legal action being taken against me/us. I/We authorise the Association to make any necessary enquiries to verify the accuracy of the information provided. I confirm that I will notify Angus Housing Association immediately of any changes in my circumstances as related in this application. I understand that the issue of this form does not guarantee an offer of housing by Angus Housing Association Limited Signature (1) Date Signature (2) Date (For joint applicants)

14 This plan shows the spread of the association s properties throughout the areas of Angus and Dundee. DYKEHEAD (RURAL) 8 BRECHIN 120 HILLSIDE MONTROSE AIRLIE (RURAL) 4 6 FORFAR 34 WESTMUIR (RURAL) 172 KIRRIEMUIR 20 GOWANBANK LETHAM 22 FERRYDEN FRIOCKHEIM 11 INVERKEILOR 5 9 AUCHMITHIE 39 ARBROATH 546 DUNDEE 531 BARNHILL 39 CARNOUSTIE 101

15 " EQUALITY OF OPPORTUNITY ID No Angus Housing Association tries to make sure that everyone who applies for housing is treated equally regardless of their race, colour, nationality, religion or sexuality. To help the Association check this happens, please answer the following questions. You may find the questions sensitive and can refuse to answer any particular question, but we would be grateful, if you could answer as many as you can. 1. Your Ethnic Background How would you describe your Ethnic Background YOU JOINT TENANT White Scottish British Irish Gypsy/Traveller Polish Any Other White Background Asian Asian Scottish or Asian British Black Black Scottish or Black British Indian Pakistani Bangladesh Chinese Any Other Asian Background African Caribbean Any Other Black Background Mixed or multiple ethnic Background Arab Arab Scottish Arab British Unknown Any Other Black Background 2. Nationality UK National, resident in UK Poland Estonia Bulgaria Lithuania Czech Republic Slovenia Latvia Slovakia Other European Economic Area (EEA) Country Romania Hungary Any other Country UK National returning from residence overseas Prefer Not to say 3. Religion Christian Muslim Buddhist Sikh Hindu Jewish I don t have a religion Prefer not to say YOU JOINT TENANT Other

16 4. Transgender & Sexuality YOU JOINT TENANT Is your gender identity the same as the gender you were assigned at birth? YES NO Prefer not to say If NO please state below whether you are a Trans Woman or Trans Man Trans Woman Trans Man 5. Disabilities Do you or anyone who will be living with you consider themselves to have a disability? Visually impaired Deaf/Hearing Impaired Dyslexia Learning Difficulties Other please give details Please return this form to either of the Association s offices at: 93 High Street Arbroath, DD11 1DP Tel: The Square, Ormiston Crescent, Dundee, DD4 0UD Tel: Angus Housing Association Limited 93 High Street Arbroath Angus DD11 1DP Tel Fax The Square Ormiston Crescent Dundee DD4 0UD Tel Fax Angus Housing Association is a registered Scottish Charity SCO20981 Property Factor Registered No. PF000129