Homebuy Application Form SECTION 1 – APPLICATION DETAILS APPLICANT 1 APPLICANT 2 Surname First Name(s) Date of Birth Home Address Postcode Telephone number(s) Email Please list all people who will be permanently living with you Surname First name(s) Relationship Date of birth Male or female Is this person living with you now? Are you pregnant or is anyone living with you pregnant? Yes No If yes, please state the name of the person who is pregnant and when the baby is due Do you have overnight access to children? Yes No If yes, please state who stays with you and on what days of the week Are you or anyone living with you disabled? Yes No If so, are they registered disabled? Yes No If so, please state their name and registered disabled number Please provide details of any current special needs or disabilities of anyone living with you that affects the suitability of your home. Do you consider the home you are living in to be suitable for your current Yes No housing needs? If no, please explain why How much equity would you prefer to purchase under Homebuy? (please tick) 50% 60% 70% In which area would you like to buy a property? Abergavenny Areas: Abergavenny Monmouth Areas: Monmouth/Wyesham Abergavenny Areas: Crucorney Fawr Monmouth Areas: Goytre Fawr (Goytre, Little (Llanvihangel, Cymyoy, Pandy) Mill) Abergavenny Areas: Grosmont Fawr (Grosmont, Monmouth Areas: Gwehelog Fawr (Gwehelog, Llanvetherine) Llancayo) Abergavenny Areas: Llanarth Fawr (Llanarth, Monmouth Areas: Llangibby Fawr (Llangibby, Llanvapley, Great Oak) Tredunnock, Gwernesney) Abergavenny Areas: Llanfoist Fawr (Llanfoist, Monmouth Areas: Llantilio United (Llantilio Govilon, Llanellen, Llanwenarth) Crossenny, Penrhos, Cross Ash, Rockfield Village, Skenfrith) Abergavenny Areas: Llanover Fawr (Llanover, The Bryn, Llanvair Kilgeddin, Llandewi Rhydderch) Monmouth Areas: Mitchel Troy United (Mitchel Troy, Dingestow, Tregare) Abergavenny Areas: Clydach Monmouth Areas: Raglan United (Raglan, Abergavenny Areas: Gilwern Penyclawdd) Abergavenny Areas: Llanelly Hill Monmouth Areas: Trellech United (Trellech, Abergavenny Areas: Llantilio Pertholey (Mardy) Catbrook, The Narth, Llanishen, Llandogo) Abergavenny Areas: Llangattock-Vibon-Avel Monmouth Areas: Llanbadoc Chepstow Areas: Chepstow Monmouth Areas: Llangwm Chepstow Areas: Caerwent Monmouth Areas: Llantrisant Fawr Chepstow Areas: Devauden Monmouth Areas: Llanhennock Chepstow Areas: Mathern Monmouth Areas: Usk Chepstow Areas: Shirenewton Caldicot Areas: Caldicot Chepstow Areas: St Arvans Caldicot Areas: Rogiet Chepstow Areas: Tintern Caldicot Areas: Portskewett Caldicot Areas: Undy/Magor SECTION 2 – ADDRESS HISTORY APPLICANT 1 APPLICANT 2 What type of housing do you currently live in? First time buyer First time buyer Living with friends/family Living with friends/family Private tenant Private tenant Council tenant Council tenant Housing Association tenant Housing Association tenant Owner occupier Owner occupier Joint owner Joint owner Other Other Not including the home you currently live in, have you previously held a Housing Association or Council tenancy? Yes No Yes No If you have held a social housing tenancy, have you ever breached your tenancy agreement in any way? E.g. anti-social behaviour Yes No Yes No If yes, please provide details Not including the home you currently live in, have you ever owned your own home or do you have a financial interest in any other property? Yes No Yes No If yes, please provide the address and dates spent at the property and state whether you still have a financial interest in the property. If you are in the process of selling your interest at the moment, please state the value of the property, outstanding mortgage and the estimated equity that you will receive following the sale. SECTION 3 –INCOME APPLICANT 1 APPLICANT 2 Employment status Full time Full time Part time Part time Self employed Self employed Seeking employment Seeking employment Unemployed Unemployed Retired Retired Student Student If working, what is your gross monthly wage (before tax and deductions)? Have you received Housing Benefit or Universal Credit housing element in the last 12 months? Yes No Yes No Do you receive any other welfare benefits? If so, please state which ones, the frequency they are paid and also the amount that is paid. Do you have any savings or investments? If so, please state the approximate amount, any income you receive from these and the frequency of payment. Do you receive any other form of income? If so, please explain what additional income, the amount and the frequency it is paid. SECTION 4 – EXPENDITURE What are the main monthly outgoings in your current home? Rent/Mortgage Leisure e.g. gym Council tax Clothing Water rates Travel expenses/petrol Gas Hire purchase Contents insurance Catalogue Electricity Credit/store card Satellite/Cable TV Child maintenance TV rental/licence Childcare costs Broadband School meals/meals at work Telephone Food and other housekeeping APPLICANT 1 APPLICANT 2 Do you have any debts? If so, please provide details on how much is owed and to whom (e.g. loans or mortgage arrears). If you have a debt, what are your monthly outgoings to service the debt? Do you have any other significant outgoings or any debt not already stated? If so, please explain what the expenditure or debt is, the amount you pay out and the frequency it is paid. SECTION 5 – FURTHER INFORMATION APPLICANT 1 APPLICANT 2 Have you ever been made bankrupt, had a county court judgement or had other legal proceedings taken against you because of debt? Yes No Yes No If yes, please provide details Have you ever received a right to buy or right to acquire discount? Yes No Yes No Do you act as guarantor for any loan? Yes No Yes No If yes, please provide details Are you being given or borrowing money from a relative or anyone else you know to help you purchase your home? Yes No Yes No If yes, please provide details of who is giving you the money and the amount you will receive. Do you have a mortgage in principle for a shared equity mortgage ? Yes No Yes No Do you have a local connection to Monmouthshire? (see Homebuy information sheet) Yes No Yes No If yes, please state your connection. Please state how you heard about the Homebuy scheme. SECTION 6 – DECLARATION I/We declare that the information that I/we have given, is true and correct. I/we understand that any false information that I/we may have given may result in me/us being disqualified from the Homebuy scheme. I/we also give my/our consent for MHA to approach and potentially share information with other agencies with respect to my/our application and personal details, for the purpose of processing my/our Homebuy application. I/We will immediately inform MHA in writing of any change in circumstances that may affect this application. I/We understand and fully agree with the information contained within the Homebuy Information Sheet. IF ONLY ONE TENANT IS PURCHASING THROUGH HOMEBUY ON A JOINT TENANCY, PLEASE TICK TO CONFIRM WHO IS BUYING THE PROPERTY Tenant 1: Name Tenant 2: Name I/We acknowledge that the current tenancy will end once the Homebuy purchase is complete. The tenant not purchasing will no longer have the security of tenure provided by their MHA tenancy agreement. PRIVACY NOTICE Monmouthshire Housing Association is a Registered Social Landlord that manages around 3,600 affordable homes in Monmouthshire. We provide support for tenants and residents in various different ways. We are collecting this information for the purpose of administering the Homebuy scheme and will use it to process your application. We will not be sharing this information with anyone outside of MHA, unless it is necessary in order to process your Homebuy application. MHA has an information security policy. Information held electronically or on paper is stored securely with appropriate controls and higher levels of security around sensitive personal data. To see a copy of our Information Security Policy go to www.monmouthshirehousing.co.uk BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU FULLY AGREE WITH THE ABOVE DECLARATION. APPLICANT 1 APPLICANT 2 PRINT FULL NAME PRINT FULL NAME SIGNATURE SIGNATURE DATE DATE ALL APPLICABLE SECTIONS OF THE APPLICATION FORM MUST BE COMPLETED IN FULL. INCOMPLETE/UNSIGNED FORMS WILL BE RETURNED TO APPLICANT(S) UNREGISTERED. FORMS MUST BE SIGNED BY HAND TO BE ACCEPTED. REMEMBER TO RETURN THIS FORM TO MHA (NANT Y PIA HOUSE, MAMHILAD TECHNOLOGY PARK, MAMHILAD, MONMOUTHSHIRE NP4 0JJ) WITH: • SUPPLY COPIES OF BIRTH CERTIFICATE/PASSPORT (FOR EACH APPLICANT) • COPIES OF BANK STATEMENTS AND WAGES SLIPS FOR THE LAST THREE MONTHS (FOR EACH APPLICANT). INCLUDE DOCUMENTATION THAT SHOWS PROOF OF ALL SAVINGS OR ANY OTHER INCOME YOU RECEIVE E.G. INVESTMENT OR A BENEFIT ENTITLEMENT • A MORTGAGE IN PRINCIPLE CERTIFICATE FROM A LENDER THAT PROVIDES HOMEBUY MORTGAGES • ALSO, WHERE APPLICABLE, APPROPRIATE PROOF OF ANY OTHER EXPENDITURE LISTED IN SECTION 4 E.G. A COPY OF ANY LOAN, FINANCE OR HIRE PURCHASE AGREEMENTS.