A Copy of the Co-Operatives Lettings Policy Will Be Made Available on Request

ALT HOUSING CO-OPERATIVE

HOUSING APPLICATION

Housing Applications will not be considered unless a satisfactory reference is provided with the returned application form A copy of the Co-operatives lettings policy will be made available on request

ABOUT THE CO-OPERATIVE

Alt Co-operative is a fully mutual co-operative based in the Liverpool 8 District off Lodge Lane. All our 139 properties are within the Liverpool 8 area based in two streets and comprise 1 and mainly 2 bed terraced houses with only a few 3 bed houses  Asbridge Street  Ritson Street We are a non-profit making Registered Provider. Every tenant is required to be a member of the Co-op by purchasing a non-interest yielding share of £1.00. Every member has a right to have a say in how the Co-operative is run, and have voting rights in the decision making process. The Co-operative is controlled by its Committee of Management which is elected unpaid members who have been voted in at the Annual General Meeting of the Co-operative, by the majority of members attending. The Co-operative is registered society under the Co-operative and Communities Benefit Societies act 2014

THIS CO-OPERATIVE IS RUN FOR ITS MEMBERS, BY ITS MEMBERS & RELIES ON ITS MEMBERS INVOLVEMENT FOR ITS CONTINUED SUCCESS Please return completed application to: Co-operatives Agent - Northwest Housing Services 19 Devonshire Road, Liverpool, L8 3TX tel no 0151 726 2237 [email protected]

of 10 HOUSING APPLICATION

About you and your household

National Insurance Sex Is this Is this number of adults who are Relation male person person to Surname First Name Date of Birth going to be re-housed to you or living be re- with you female with you housed now? with you? / / / / / / You

/ / / / / /

Current address and postcode

email address:

Phone Number Home: Work:

Mobile Number

How long have you lived here? (we need proof of this)

Can we contact you at your home address? Yes No

If ‘NO’, please give an address or phone number where we can contact you and when is the best time to contact you?

Is anybody on your application expecting a baby Yes No

If ‘YES’, please give the name of the person and the date the baby is due. (Proof required)

of 10 Immigration Status

Is anybody on your application restricted by immigration rules Yes No

If ‘YES’, please give details

Income Details

Please tick the box that best describes you and your partner You Your Partner

Working full time (over 16 hours) Yes No

Working part time Yes No

Looking after children or someone sick or elderly Yes No

Looking for a job Yes No

Pensioner or retired Yes No

Long term sick or disabled Yes No

Not looking for work Yes No

Full time student Yes No

Government training scheme Yes No

Other (please give details) Yes No

Please tick the box that best applies to you and/or your partner. Do not include Child Benefit, Housing Benefit and Council Tax Benefit. Benefits You Your Partner

Income Support or Jobseeker’s Allowance or ESA Amount £ £

Wages/Employed (please give employers details below) Amount £ £

You Your Partner Address: Address:

Telephone Number Telephone Number

Working Families’ Tax Credit Yes No

Disability Living Allowance or Attendance Allowance Yes No

State retirement pension Yes No

Company pension Yes No

Other state benefits Yes No

of 10 OtherPrevious (please Address/es give details) Yes No

Please list the previous address of all the adults you have included in your application for re-housing, for the last five years. Start with the address you live at now. We may use this information to get references from previous landlords.

Name Previous Address Dates from – to Landlord

Which of the following best describes your situation?

Please tick one box in each column:

Type of occupancy Type of accommodation

Council tenant House

Private tenant Maisonette

Living in property I own Flat

Housing association tenant Bed and Breakfast

Living with friends or relatives Hospital

Lodger Bungalow

Hospital or residential home Bedsit

In prison Caravan or mobile home

Accommodation with job Hostel

Member of armed forces Sheltered or supported housing

Other (Please give details) Other (Please give details)

Are you a tenant at your current home? Yes No

Are you an owner occupier at your current home? Yes No

Do you have an assured shorthold tenancy, a licence, or a Starter tenancy (e.g. six month, 12 month)?

How many bedrooms do you have 1 2 3 4 5

of 10 Have you ever been evicted? Yes No If ‘YES’, give us the following information

The address you were evicted from

The landlord’s name

The reason you were evicted

The date you were evicted

Criminal Convictions

Have you, or anyone on your application, any criminal convictions for firearms offences or drug related offences?

If ‘YES’ please give details of the offences, including dates and sentences.

Health – disabilities or mental health

Please tell us if you or anybody else on your application is disabled or has a history of mental health

You Your partner Other people

Briefly describe the nature of your disability/mental health and provide relevant contacts for support services involved (all information provided is confidential)

of 10 Reasons why you need re-housing

Tick the boxes that best describe why you need re-housing. (*Proof will be required)

Split up from partner To get children into a better school

Losing home with job* Neighbourhood problems

Landlord selling property* Health reasons*

Want to move to a better area Overcrowding

Victim of crime or fear of crime Building Society repossession*

Need a smaller property Asked to leave by friends or relatives

To leave home Cannot afford present housing

To be nearer friends and family Nearer current employment

Living apart from family To give support

Eviction order* To receive support

Poor condition of property Need a larger home

Other (Please give details)

Are you suffering from harassment or domestic violence (Proof required) Yes No (attach separate sheet giving details if necessary)

What type of housing would you consider? (please see attached information sheet for choices available for this Co-operative)

House Maisonette

Flat Bungalow

Bedsit

How many bedrooms do you need? 1 2 3 4 5

Please refer to the front cover of this application form. This provides details of availability of different types of homes.

of 10 Please use area below to detail relevant additional information which may support your housing need

of 10 Declaration

Are you Board Member or an employee of Northwest Housing Yes No Services – or related to or have connections with a Board Member of NWHS

If ‘YES’ give details

Are you related/or have any connection to a committee member of Yes No The Co-operative

If ‘YES’ give details

Data Protection Act We register the information you give us on your housing application form in line with the Data Protection Act. We may share the information with other landlords or ask for references from your previous landlords. It is important that the information you give us is accurate. We may use certain information on your form to check the accuracy with the department of Work and Pensions, Police, Probation and Social Services Liverpool City Council ( i.e.Supported Living and the Homelessness team)and other registered social landlords and private landlords or their agents.

In completing this form, you understand that in order to process your application we must share information you have provided with all the agencies identified mentioned within this application. All information which you have provided is processed in accordance with the Data Protection Act 1998 and the obligations which are placed on Data Controllers

Please Read & Sign the Declaration

As far as I know, the answers I have given on this form are true. I understand that I may lose any housing or tenancy if I have given false information. I understand that all the information I have given will be put on the landlord’s computer. I will tell the Co-op immediately if there is any change to the circumstances I have told you about in this form. I understand that by signing this declaration I am giving permission to contact any previous landlords and relevant agencies to check the information and release any relevant information. I agree to the information provided being shared with other housing agencies.

Your signature Date:

Your partners signature Date:

Please return your completed application form to:

Agents: NORTHWEST HOUSING SERVICES 19 Devonshire Road L8 3TX T 0151 726 2200 F 0151 726 2250 W www.nwhousing.org.uk Professional services to registered housing providers & the third sector

Customer led, ethicallyPage guided, 8 of 10 mutually owned Checklist

Proofs of Residence- we will require 2 proofs of residence for all adults listed and one proof for all children listed i.e. Child Tax Credit, if you are pregnant, you will need to provide a letter or a certificate from your doctor as proof. We will also require proof of National Insurance number – this information will be requested at the Home visit stage - DO NOT PROVIDE THIS INFORMATION WITH THIS APPLICATION

Some examples of proofs of National Insurance and residency we may need to see at interview stage:

Benefit Agency letter P60 Recent paid Utility Bill

Child Tax Credit National Insurance Card Medical Card

Wage Slip Bank Statement Driving License

Equal opportunities monitoring form

We are committed to fighting discrimination and inequality in our service to the public. To help us monitor the success of our equal opportunities policy, it would be helpful if you could fill in this form. If you do not wish to fill in this form, it will not affect your application. We will not pass on the information you give us to anyone else, and will only be used to monitor, develop and improve our housing policies.

Please tell us your Nationality/Country Your Other You Of Origin by ticking the relevant box Partner People

Caribbean

African

South East Asian

British European

Chinese

Yemeni

Travellers

Gypsies

Romanian

Polish

Combination/Mixed race

Declined to answer

Your Other Only tick one box in each column You Partner People

of 10 Black

Mixed Race

If you think that the categories above are not applicable, you can use this space to tell us why.

Your Other Religion You Partner People

Christian (include Church of England, Catholic, Protestant And all other Christian denominations

Buddhist

Jewish

Muslim

Prefer not to say

Thank you for your help. This information will help us make sure we run our services fairly- we may use information you have given on this form to analyse demand for our properties