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Application for Housing Dumfries and Galloway Common Application for Housing Dumfries and Galloway Common Housing Register (Coming 2018/2019) Available for translation into community languages, large print and formats such as Braille on request Declaration Guidance Notes Before completing this form please read through the following statements and sign at the Please print clearly and answer all the questions as fully as possible. If you need support to complete bottom to show that you understand and agree with them. this form, please call us on 0300 123 1230. I agree: Once your application has been registered on our housing list, we will send you a registration letter. • That you may process my/our personal data as in the aforementioned statement, which may include The registration letter will tell you your application number and how many points you have been contacting and sharing information with my/our current/previous landlords, my/our doctor, hospital awarded. consultant, health visitor, social work and health professionals, police and criminal justice or any other relevant person, if more information is needed in connection with my/our housing application Your application will be treated in confidence and in compliance with the Data Protection Act • That I/we will inform Homes4D&G of any change in my/our circumstances 2018 • That all information given by me/us to Homes4D&G is true and accurate • That if I/we are given a tenancy because I/we have supplied false information or I/we have held back any information that the landlord will take action to end the tenancy. What we will do with your information/personal data: • If I/we accept a property offered through Homes4D&G including mutual exchange that my/our application will be cancelled and that I/we will have to submit a fresh application if I/we wish to move Homes4D&G is a partnership involving Dumfries & Galloway Council and Registered Social again. Landlords: Dumfries and Galloway Housing Partnership, Home Group, Irvine Housing Association and Cunninghame Housing Association. Applicant’s Signature Date We will use the information you provide to Homes4D&G to process your application for housing. The information will be shared with the Homes4D&G partners. Joint Applicant’s Signature Date With your permission we may contact others to get more information to help us process your Please note that if this declaration is not completed then we will be unable to process application. This may include: your application • Your current or previous landlords • Medical and Health professionals Application deferral • Police • Others with relevant information If you do not wish to be considered for a property in the foreseeable future, you can choose to defer (postpone) your application This information will be used to assess your application in accordance with the Homes 4 D&G Do you wish your application to be deferred? Yes No Common Allocation Policy and match your requirements and preferences against any available properties. If yes, please give your reasons and provide the date you wish your application to be deferred until: The information will also be used for statistical and monitoring purposes. Reason: We will not disclose your personal data beyond the Homes4D&G partners except where required to Please defer my application until Month: Year: do so by law unless you have given your permission to do so. Do you require the services of an interpreter? Yes No If yes, please provide details 22 3 Declaration Guidance Notes Before completing this form please read through the following statements and sign at the Please print clearly and answer all the questions as fully as possible. If you need support to complete bottom to show that you understand and agree with them. this form, please call us on 0300 123 1230. I agree: Once your application has been registered on our housing list, we will send you a registration letter. • That you may process my/our personal data as in the aforementioned statement, which may include The registration letter will tell you your application number and how many points you have been contacting and sharing information with my/our current/previous landlords, my/our doctor, hospital awarded. consultant, health visitor, social work and health professionals, police and criminal justice or any other relevant person, if more information is needed in connection with my/our housing application Your application will be treated in confidence and in compliance with the Data Protection Act • That I/we will inform Homes4D&G of any change in my/our circumstances 2018 • That all information given by me/us to Homes4D&G is true and accurate • That if I/we are given a tenancy because I/we have supplied false information or I/we have held back any information that the landlord will take action to end the tenancy. What we will do with your information/personal data: • If I/we accept a property offered through Homes4D&G including mutual exchange that my/our application will be cancelled and that I/we will have to submit a fresh application if I/we wish to move Homes4D&G is a partnership involving Dumfries & Galloway Council and Registered Social again. Landlords: Dumfries and Galloway Housing Partnership, Home Group, Irvine Housing Association and Cunninghame Housing Association. Applicant’s Signature Date We will use the information you provide to Homes4D&G to process your application for housing. The information will be shared with the Homes4D&G partners. Joint Applicant’s Signature Date With your permission we may contact others to get more information to help us process your Please note that if this declaration is not completed then we will be unable to process application. This may include: your application • Your current or previous landlords • Medical and Health professionals Application deferral • Police • Others with relevant information If you do not wish to be considered for a property in the foreseeable future, you can choose to defer (postpone) your application This information will be used to assess your application in accordance with the Homes 4 D&G Do you wish your application to be deferred? Yes No Common Allocation Policy and match your requirements and preferences against any available properties. If yes, please give your reasons and provide the date you wish your application to be deferred until: The information will also be used for statistical and monitoring purposes. Reason: We will not disclose your personal data beyond the Homes4D&G partners except where required to Please defer my application until Month: Year: do so by law unless you have given your permission to do so. Do you require the services of an interpreter? Yes No If yes, please provide details 2 3 3 Section 1 – Name and address Correspondence Address If you would like us to write to you at another address, or if you have no permanent address, please Main Applicant Joint Applicant provide details: Title Title Surname Surname First name(s) First name(s) Section 2 – Your present accommodation Date of birth Date of birth When did you move into your present address? Main applicant Joint applicant Gender Gender Date Date Preferred Preferred pronoun pronoun Please tick the box that best describes your current accommodation Are you? (Please tick) √ Name you would Name you would like to be called like to be called A tenant of DGHP Living with family A tenant of Home Group Living with non-family House number House number A tenant of Irvine Housing Association A lodger A tenant of Cunninghame HA Street name Street name A tenant of a housing association or Staying in supported accommodation co-operative out with D&G Town Town A tenant of another housing association or Staying in homeless bed and breakfast co-operative within D&G accommodation Postcode Postcode No permanent accommodation (NFA) / Staying in homeless furnished Living rough accommodation Telephone Mobile Telephone Mobile A shared owner of a house with a housing In HM Forces tied accommodation Home Home association Work Work A tenant of a private landlord In residential care Email address Email address A tenant of tied accommodation In prison An owner occupier In hospital Marital status Marital status Staying in a mobile home or caravan If none of the above apply, give details here Nat. Ins. number Nat. Ins. number First language First language If none of the above apply, please give details here Nationality Nationality Relationship to main applicant Known by any other name Who is the landlord of your current address? (where applicable) Have you or any joint applicant ever been known by any other name? Yes No Name and address of landlord If yes, please provide details: Main Applicant Joint Applicant Names Dates Names Dates Contact telephone number 44 5 Section 1 – Name and address Correspondence Address If you would like us to write to you at another address, or if you have no permanent address, please Main Applicant Joint Applicant provide details: Title Title Surname Surname First name(s) First name(s) Section 2 – Your present accommodation Date of birth Date of birth When did you move into your present address? Main applicant Joint applicant Gender Gender Date Date Preferred Preferred pronoun pronoun Please tick the box that best describes your current accommodation Are you? (Please tick) √ Name you would Name you would like to be called like to be called A tenant of DGHP Living with family A tenant of Home Group Living with non-family House number House number A tenant of Irvine Housing Association A lodger A tenant of Cunninghame HA Street name Street name A tenant of a housing association
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