East Staffordshire Housing Register Application Form Working in partnership with: 1 Trent & Dove Housing Limited Registered Office: Trinity Square, Horninglow Street Burton upon Trent, Staffordshire DE14 1BL T: 01283 528528 E: [email protected] W: www.trentanddove.org Dear Applicant, Please be advised that Trent & Dove will be accepting online forms ONLY as of 22nd September 2020. Therefore, should you wish to submit this paper application, please note that the last date for submission will be 21st September 2020. Any paper forms received after this date will be returned to you with a request to re-submit online. Should you have any queries regarding this, please have a look at our website at www.trentanddove.org, our Facebook page or call our customer services team on 01283 528 528. Yours Faithfully, Housing Needs Team Trent & Dove Housing Ltd Trent & Dove Housing Limited is a registered society under the Co-operative and Community Benefit Societies Act 2014. Registered No. 30668R VAT Reg No. 173 4107 26 Chief Executive: Ursula Bennion 2 Please refer to the ‘Checklist’ on Pages 4 & 5 and ensure you have provided all relevant information before submitting your application. Please be aware that your application form may be refused or returned to you if you fail to provide sufficient supporting information. Office Use Only Date Received ID Check Orchard Rents Check Arrears £_______________ Referral Made Date Inputted Form Return Reason: APPLICATION REF NO: 3 Checklist Before you submit your application, please tick the boxes to ensure you have done the following. Please refer to page 21 for ways in which to return your completed application form You have provided 2 original proofs of identification for each adult household member; one of personal identity and one showing your current address. Please refer to Page 21 for acceptable proofs of identification. Please note: any originals sent to support your application will be returned to you within 10 working days through “Royal Mail Signed for” services. If you hand deliver your application to our offices, a copy of the originals will be taken at the time and handed back to you at the same time. You have completed all of the pages on this form before submitting your application. Please note, if you have not completed the entire application form, it will be returned to you. You (and joint applicant if applicable) have signed and dated this application form on Page 15. You have provided a Landlord Reference for your current and/or previous tenancies over the last 2 year period by your landlord(s). Please note, this must be completed by your landlord only. You have provided two months recent bank statements for each applicant. This is to ensure ability to pay rent in the future You have provided proof of income. This can be recent wage slips and/or award letters for any benefits you are currently in receipt of. Provided proof for any additional information that you feel may help your application and identifies your housing need, such as; Disability Living Allowance/Carers Allowance, PIP If any of the following are relevant to your circumstances, please tick the box to ensure they are completed also; If you need to move due to a medical or welfare condition, please complete the attached questionnaire at the end of this application form. If you are pregnant you must provide proof of pregnancy stating your estimated due date if would like your bedroom entitlement to reflect an expected child. This would be your MATB1 certificate from your midwife. If you are a victim of domestic abuse, please provide supporting evidence such as Crime reference numbers and details of any professional who is currently supporting you so we can ensure you will be re-housed appropriately and any further support needs. 4 If you have come to the UK from the EEA (European Economic Area); If you have come to the UK from the EEA we will need proof of employment or other means to fund your housing. Proof of ‘leave to remain’ or recourse to public funds (Non-EEA Applicants) If you are lodging or renting a room only; Proof that you are not on any current tenancy or mortgage. Proof that you are only renting one room Are you subject to any immigration controls? Main Joint Yes No Yes No Applicant Applicant If yes, please give details; 5 Applicant Overview Title Full Name (please include any middle names) Main Applicant Joint Applicant Previous Names Please state if you have been known by another name, including maiden name, former marriage name, change by Deed Poll, or any other name Main Applicant Joint Applicant Are you male or female? Main Applicant Male Female Joint Applicant Male Female Date of Birth Main Applicant Joint Applicant What is Joint Applicants relationship to Main Applicant? Joint Applicant National Insurance Number this information is obtained to check for any previous tenancies held within East Staffordshire Borough Council. The information will be held on our systems and may be used to assist benefit claims in the future. You can choose not to supply your National Insurance Number however this may slow down the processing of your application. You will find this on your National Insurance Card, your pay slips or from tax papers Letters Numbers Letter Main Applicant _ _ _ _ _ _ _ _ _ Joint Applicant _ _ _ _ _ _ _ _ _ NB – failure to supply us with your National Insurance number may result in further checks being made and will cause a delay in being accepted on the waiting list. 6 Current Address - When your application has been assessed we will write to you to tell you what your application number, your banding and how many bedrooms you’re entitled to. If you are of no fixed address, you need to give us the address you stay at most often. If you are street homeless, do not put an address here. Main Applicant Postcode: Joint Applicant Postcode: From Date: To Date: Main Applicant Joint Applicant Contact Address - In some circumstances, you may like your post to go to a different address, please enter an address below if this applies to you. If you are street homeless or are of no fixed address, you need to give us a contact address here. Main Applicant Postcode Joint Applicant Postcode Contact information There may be occasions during the application stage where we may need to contact you to request more information or to discuss your application. Please provide your telephone number and email address if you are happy for us to contact you for further information. (Please note this could speed up processes not having to write to you). We will also use this information to contact you if you are offered a property. Home Mobile Email Address Main Applicant Joint Applicant 7 Current Circumstances What type of dwelling do you live in? House Bungalow Maisonette Bedsit Hostel Main Applicant Flat B&B Caravan Prison Other ________________ House Bungalow Maisonette Bedsit Hostel Joint Applicant Flat B&B Caravan Prison Other ________________ If you live in a flat, maisonette or bedsit what floor is it situated on? Ground First Second or Above What is the tenure of your current property? Council Tenant Housing Association Tenant Lodger Relatives or Friends Owner Occupier Private Tenant How many bedrooms are in your current property? Main Applicant Joint Applicant Do you own any other property in the UK or overseas? If yes, please give us both valuation and equity amounts Main Applicant Yes Amounts = No Joint Applicant Yes Amounts = No Please complete full details of your current landlord – MUST include name, address and telephone number. Main Applicant Joint Applicant If yes we will need to ask you more information about this to assess your eligibility. Please note owning another property does not necessarily mean that you won’t be entitled to a property with Trent & Dove Housing Ltd. *References need to be supplied by you from your landlord(s) from the last 2 years as part of the application process and offers will not be made until receipt of the completed reference. * 8 Income and Expenditure completion of this form will help you understand affordability of properties. Please provide two months of recent bank statements Name: Main Joint Expenditure: Main Joint Income: weekly/monthly Applicant Applicant weekly/monthly Applicant Applicant Wages Mortgage/Rent Partner's Wages Council Tax Is your current wage a Insurance (car & zero hours, temporary or house) permanent contract? Child Benefit Gas Tax Credits Electric Jobseekers Water Allowance/Universal Credit Employment and Support Mobile Allowance Income Support Landline Attendance Internet/TV Allowance/Disability Living Allowance/Personal Independence Payment Carer's Allowance Travel costs State Retirement Pension Food Pension Credit School Dinners Other Pensions Clothing Maintenance Rental agreements Non Dependent Court Fines Contribution Other Income Maintenance Pets Social Fund Loan Debts/Payment Plans Health Costs Other expenditure Total Total Income Expenditure Please state the amount of savings you have £ I understand that this information forms part of my application for housing and is covered by the declaration within the main application form. 9 Your current household Other than the main and joint applicant listed, please complete the details of every person that is looking to be re-housed with you, including children. This information is vital to ensure we assess your bedroom entitlement correctly as per ESBC Allocations Policy. Currently living in your Relationship Date of Gender First Name Last Name household to applicant birth M/F Y/N Please complete details of every person, including children, who are currently living in your household but who will NOT be rehoused with you.