HousingApplicationForm_1.pdf

East Herts District Council

Housing Application Form

Before completing the application form please read it through

carefully. Make sure you answer all questions fully. In order to help

us process your form please provide all the relevant

documentation requested below.

If you require any help in filling in the application form please do

not hesitate to contact the Housing Options Team on 01279 655

261.

PLEASE PROVIDE PHOTOCOPIES – NOT ORIGINAL

DOCUMENTS. (N.B. We may request original documents at a

later date if necessary.)

Proof of identity – Birth certificates for all British adults and

children included on the housing application; passports and

immigration documents for adults and children of any other

nationality. (Please ensure that every page of the passport that

contains an entry is copied and any immigration stamps can be

read clearly.)

Proof of any Benefits received for you and your children – e.g

Child Benefit, Tax Credits, JSA, Income Support etc.

Proof of income and savings – e.g. copies of bank statements,

savings passbook and last 3 payslips.

Proof of pregnancy – a copy of the scan photograph is required,

plus a document from the hospital maternity records confirming the

expected date of delivery (EDD).

(PLEASE NOTE: YOUR HOUSING APPLICATION WILL NOT

BE PROCESSED UNTIL COPIES OF THE APPROPRIATE

DOCUMENTS HAVE BEEN RECEIVED.)

HOUSING APPLICATION

The information you provide on this form will be

treated in the strictest confidence and will be

used by Housing staff to determine your eligibility

and need for housing. Please answer all the

questions as fully as possible. Ask if you need

help with completing this form.

Office Use Only

Ref No:

Date:

Initials:

Section A: Applicant Details

Applicant

Partner

Mr/Mrs/Miss/Ms/Other (Please state)

Surname

Forenames

Date of Birth

National Insurance Number

Current Address

(If different from applicant)

Postcode

Daytime Tel No: (Incl STD code)

Home Tel No: (If different)

Mobile Tel No:

Email Address

Please provide details of other persons in your household in addition to those listed above who are to be housed

with you.

Surname

Forenames

Date of

M/F

Relationship

Please give details if you, or anyone above, are expecting a child.

Name

Expected Date of Birth

(Written proof of pregnancy is required from a GP or midwife)

www.eastherts.gov.uk

Birth

to Applicant

The following question must be answered by all applicants.

Are you, or anybody on your application, subject to any immigration controls due

to a status as a ‘person from abroad’ under the 1996 Asylum & Immigration Act?

Yes

If you answer Yes to this question, please contact a member of the Housing Options Team before continuing

with this application.

Section B: Present and Past Residences

Please give details of all your addresses for the last 15 years. Start with the most recent. If there are more than four

addresses, then please continue on a separate sheet.

Applicant

From

1. Present Address

Partner

From

If you or your partner have lived in East Hertfordshire for less than one year please give details of any employment

you have had in East Hertfordshire.

Name

Please state name of employer, location of work, and dates of employment

If you or your partner have previously applied to East Herts Council for housing, please provide details if possible, and

also the name you applied under, if different.

Applicant

Partner

If you or your partner have ever held a Council or Housing Association tenancy, please provide details below.

Name of

Reason for

Address

Dates

Landlord

Leaving

Applicant

Partner

If you or your partner have ever owned a home, please state the address and when you owned it.

Applicant

Partner

Address

Dates

From

If you and your partner live outside East Herts and are of retirement age, but have a close relative or any other strong

connection with East Hertfordshire, please give details below.

Section C: Your Present Accommodation

Security of Tenure

Are you being asked to leave your present home within the next year? Yes No

(Please provide written proof from your landlord and additional details on Page 6 of this form - Further Information)

For each section below, please tick the boxes which best describe your housing

Property Type

Tenancy Type

House

Private Tenant

Bungalow

Owner Occupier

Maisonette

HM Forces

Ground Floor Flat

Hospital

Upstairs Flat

With Parents

Sheltered Scheme

With Friends

Bedsit

Lodgings

Mobile Home / Caravan

Housing provided with your job

B&B / Hotel

Housing Association Tenant

Council Hostel

Local Authority Council Tenant

Other (Please state)

Te m p o ra r y a ccommodation provided by the Council

that is not self-contained

Te m p o ra r y a ccommodation provided by the Council

that is self-contained

No Fixed Abode

Other (Please state)

Yo u r l i v i n g sp a ce

Please count the rooms you use as bedrooms.

Include living rooms if someone sleeps there regularly. Do not count kitchens or bathrooms.

Is it a

Tick if shared

with people

State if a

double

with relatives

relatives and

Room bedroom or

or single

not on your

Count living room Names of people sleeping in this room

sized room?

application

Facilities

Please tick if you have these facilities.

Tick if you

How many people

in total do you

have this

are not included

Facility

facility

on your application?

Kitchen

Bathroom

To ilet

Running hot and cold water

Defects

Does your home have any major defects, such as dampness?

Yes

If yes, please describe:

Details of Your Rent or Mortgage

Applicant

Partner

Rent or mortgage per month

Are you in arrears?

Yes

If ‘Yes’, how much do you owe?

who are not

share these with who

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