AffordableHousing Permit application under Article 2.4 paragraph 2 of the Huisvestingsverordening Den Haag 2019
Date of receipt
The following municipalities work together to coordinate the allocation of rental properties in the Haaglanden region: Delft, The Hague, Leidschendam-Voorburg, Midden-Delfland, Pijnacker-Nootdorp, Rijswijk, Wassenaar, Westland and Zoetermeer. An affordable housing permit is required for a self-contained residence with a rent up to € 951.19. Applying for this permit does not automatically guarantee that the permit will be granted.
Incomplete application forms will not be processed. • Providing incomplete or incorrect information may result in a housing permit being revoked at a later date. • An administrative fee is required to process your application. You must pay this fee at the cash desk of the Department of Public Service at 1 of the city district offices unless you are applying for a rental property in the social housing sector. • If you are applying for a housing permit in the social housing sector, you should pay the fee to the housing corporation.
1 Details about the rental property Street House number Postal code Municipality
Type of residence Social housing Other rental property below € 720.42 Other rental property with a rental price between € 720.42 and € 951.19 and/or valued at 185 points or less according to the rental valuation system.
2 Information about applicant Please fill in your personal details as they are registered with the Department of Public Service. Married women and widows must also state their maiden name.
Initial(s) First name
Surname Gender M F Marital status Unmarried Married Divorced Widow/widower Date of birth Country of birth Nationality
Street House number Postal code City/Town Daytime telephone Postal address Number of persons moving with you
Affordable Housing Permit application 1/4 191211_BSD_A4_Formulier_Application Affordable Housing Permit_v2t Housing Affordable 191211_BSD_A4_Formulier_Application 3 Details of the persons moving with you and household income ‘Taxable annual income’ refers to your income according to your income tax returns, or your (total) income according to the enclosed copies of your annual income statement(s).
A Applicant’s (taxable) annual income €
B Other members of the household and children aged 23 and older Initial(s) Surname
Date of birth Gender M F Street House number Postal code City/Town Daytime telephone Postal address
Relationship to the applicant Partner Child Other persons moving with you (Taxable) annual income € +
Initial(s) Surname
Date of birth Gender M F Street House number Postal code City/Town Daytime telephone Postal address
Relationship to the applicant Partner Child Other persons moving with you (Taxable) annual income € +
Initial(s) Surname
Date of birth Gender M F Street House number Postal code City/Town Daytime telephone Postal address
Relationship to the applicant Partner Child Other persons moving with you (Taxable) annual income € +
Initial(s) Surname
Date of birth Gender M F Street House number Postal code City/Town Daytime telephone Postal address
Relationship to the applicant Partner Child Other persons moving with you (Taxable) annual income € +
Initial(s) Surname
Date of birth Gender M F Street House number Postal code City/Town Daytime telephone Postal address
Relationship to the applicant Partner Child Other persons moving with you (Taxable) annual income € +
Affordable Housing Permit application 2/4 3 Continued Initial(s) Surname
Date of birth Gender M F Street House number Postal code City/Town Daytime telephone Postal address
Relationship to the applicant Partner Child Other persons moving with you (Taxable) annual income € +
Initial(s) Surname
Date of birth Gender M F Street House number Postal code City/Town Daytime telephone Postal address
Relationship to the applicant Partner Child Other persons moving with you (Taxable) annual income € +
The details you provide for all the persons moving with you must correspond with the information registered with the Department of Public Service.
C Total taxable annual income € =
4 Rental property to become available
A Will a property/properties become available because you are moving? Yes No Date it will be available
Street House number Postal code Municipality Name of owner/manager Address of owner/manager Rental property Owner-occupied property
Street House number Postal code Municipality Name of owner/manager Address of owner/manager Rental property Owner-occupied property
Will there be a housing exchange? Yes No
5 Do you have a priority declaration for the Haaglanden housing market? Yes Date of issue For which municipality No
Affordable Housing Permit application 3/4 6 Owner’s declaration (for the property specified in Question 1)
The undersigned
Initial(s) Surname Gender M F Street House number Postal code City/Town Telephone
The owner/manager of the property specified in Question 1 hereby declares he/she is willing to rent out the following property
Street House number Ground floor floor
Number of rooms Total floor area of the property Starting on Until
Basic rent € Service fees € Heating costs € Total rent €
First issue (new building) Yes No City/Town Date
Signature of owner/manager
7 Required enclosures for this application • the most recent income specification(s) for you and all members of your household for the last 3 months. This can be the salary slip from your employer or the monthly statement from the benefits agency or pension provider; • a copy of the rental contract signed by the landlord and the tenant or a declaration by the owner signed by the owner; • if you do not have Dutch nationality: a copy of a valid residence permit for the Netherlands; • if you are divorced: a copy of the temporary arrangement or another legally valid document in which the custody of the children has been arranged; • other enclosures, i.e.:
Total number of enclosures
8 Declaration and signature The undersigned declares that the information provided on this application form and in the enclosure(s) is true and correct.
City/Town Date
Signature of applicant
Please note: the attachments are required. Incomplete applications will not be processed.
Affordable Housing Permit application 4/4