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If You Want to Be Considered for Social Housing Please Tick Box Below

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If You Want to Be Considered for Social Housing Please Tick Box Below Social Housing Assessment 2017 APPLICATION FOR SOCIAL HOUSING – UPDATE OF DETAILS Please complete this form if you want Limerick City and County Council to consider you for permanent Council housing. Once the form is completed please return using the enclosed prepaid and addressed envelope to: Community Support Services, Limerick City & County Council, Merchants Quay, Limerick City, V94 EH90. If you do not return the form by 21st April 2017 the Council will close your application for housing in accordance with statutory guidelines. A failure to reply in full indicates that you no longer wish to be considered for Social Housing. WHAT DOCUMENTS DO I NEED TO INCLUDE WITH THIS FORM? If your circumstances have changed since your previous housing application you will need to provide the Council with copies of the relevant document(s). The table below provides a summary of the document(s) needed depending on the change to your circumstances from when you were last assessed by the Council. Any new household member(s) (e.g. new births, Birth Certificate and PPS number new applicant added to household) Any recent Marriages or Civil Partnerships Marriage/Civil Partnership certificate If a member of the household is currently Latest P60 employed The last 3 payslips If a member of the household is currently self- 2 years of accounts employed Any household member(s) in receipt of social A recent payment slip from the Department welfare of Social Protection. Any household member(s) who is a non-EEA A copy of the latest GNIB card national A copy of the latest Stamp endorsement on the passport Any recent legal separation or divorce Copy of the agreement Any recent custody arrangement Document which sets out the arrangements Any recent maintenance arrangements Document which sets out how much maintenance is received If you want to be considered for Social Housing please tick box below: PROCESSING DETAILS Are you still interested in receiving Social Housing? (tick) Yes No Housing list number (if known) Limerick City and County Council, Merchant's Quay, Limerick, V94 EH90 Page 1 of 8 Social Housing Assessment 2017 1. Name of First Applicant Full name Email address Phone number Civil status (please tick) Single Widowed Married Divorced Civil Partner Separated Cohabiting Legally Separated Other Employment status (please tick the box which applies to you) NB evidence of income must be submitted. Employed (full-time or part-time) Unemployed (receiving social community/ Homemaker (no income) welfare benefit) Self-Employed Pensioner/Retired Student/Child Employed in Back to Work/FÁS Scheme One Parent Family Support only Other, please specify: 2. Joint Applicant details (please write in the following or tick where indicated) Name of Joint Applicant Relationship to yourself e.g. partner, spouse. Civil status of Joint Applicant Single Widowed (please tick) Married Divorced Civil Partner Separated Cohabiting Legally Separated Other Employment status (please tick the box which applies to the Joint Applicant) NB evidence of income must be submitted Employed (full-time or part-time) Unemployed (receiving social community/ Homemaker (no income) welfare benefit) Self-Employed Pensioner/Retired Student/Child Employed in Back to Work/FÁS Scheme One Parent Family Support only Other, please specify: Limerick City and County Council, Merchant's Quay, Limerick, V94 EH90 Page 2 of 8 Social Housing Assessment 2017 3. Income details (please fill out the following about WEEKLY income for you and the Joint Applicant) N.B. evidence of income must be submitted. Income types (per week) You Joint Applicant Employment income € € Self – employment income € € Social welfare income € € Social Welfare payments (please write in names of the payments received e.g Job Seekers Allowance) Maintenance received € € Any other income € € Other income type (Please write in where any other income is from) 4. Details of any children/dependents or anyone else to be included on the application (please write in the following or tick where indicated) N.B. Evidence of income must be submitted. Name (1) Date of Birth PPSN Employment/Education status (please tick the box which applies to this person) Employed (full-time or part-time) Unemployed (receiving social community/ Homemaker (no income) welfare benefit) Self-Employed Pensioner/Retired Student/Child Employed in Back to Work/FÁS Scheme One Parent Family Support only Other, please specify: Their weekly income (If over 18) € Name (2) Date of Birth PPSN Employment/Education status (please tick the box which applies to this person) Employed (full-time or part-time) Unemployed (receiving social community/ Homemaker (no income) welfare benefit) Self-Employed Pensioner/Retired Student/Child Employed in Back to Work/FÁS Scheme One Parent Family Support only Other, please specify: Their weekly income (If over 18) € Limerick City and County Council, Merchant's Quay, Limerick, V94 EH90 Page 3 of 8 Social Housing Assessment 2017 Name (3) Date of Birth PPSN Employment/Education status (please tick the box which applies to this person) Employed (full-time or part-time) Unemployed (receiving social community/ Homemaker (no income) welfare benefit) Self-Employed Pensioner/Retired Student/Child Employed in Back to Work/FÁS Scheme One Parent Family Support only Other, please specify: Their weekly income (If over 18) € Name (4) Date of Birth PPSN Employment/Education status (please tick the box which applies to this person) Unemployed (receiving social community/ Employed (full-time or part-time) Homemaker (no income) welfare benefit) Self-Employed Pensioner/Retired Student/Child Employed in Back to Work/FÁS Scheme One Parent Family Support only Other, please specify: Their weekly income (If over 18) € 5. Disability and/or Medical Information Does anyone in the household have a Yes No disability or medical condition? Person’s name _____________________________ Please describe the disability or medical condition If someone in the household has a disability, please indicate if the disability falls into any of the following categories (you may tick more than one) Intellectual disability Yes No Mental health disability Yes No Physical disability Yes No Sensory disability Yes No Due to the disability or medical condition Yes No are there any particular requirements needed in a home? Please note, a report from a consultant is required (please tick) If so please describe the particular requirements (e.g. wheelchair access) Limerick City and County Council, Merchant's Quay, Limerick, V94 EH90 Page 4 of 8 Social Housing Assessment 2017 6. Traveller specific accommodation Do you require Traveller specific Yes No accommodation? (please tick) 7. Where the household lives (please write in the following or tick where indicated) Current address (please write in) Last previous address before this (please write in) Where do you live now? (please tick the box which best describes your current living arrangement) With parents Private Rented Accommodation With relatives/friends with rent supplement Owner occupier without rent supplement Other, please give details below: Emergency Accommodation/None If you are renting, please write in when your tenancy started or when you moved in (dd/mm/yy) Landlord’s name Landlord’s phone number How much rent do you pay a month or week? € How much rent supplement do you get each week (if any)? € What type of accommodation do you live in at present? (please tick the box below which describes your current accommodation) House Mobile Home Transitional Accommodation Hospital Cottage Maisonette/Duplex Tigín Institution Apartment Day House Bed and Breakfast Refuge Flat Group Housing Hostel Prison Caravan Halting Bay Sheltered Accommodation None/Other What facilities do you have in your current accommodation? (please tick the boxes which apply) Kitchen Living Room Bathroom Toilet Central Heating Water supply - COLD Water supply - HOT How many bedrooms are there in your current property? (please write in number) Do you share some rooms with another household i.e. Yes No persons not on this form? (please tick) If so, please write in what rooms you have to share. Limerick City and County Council, Merchant's Quay, Limerick, V94 EH90 Page 5 of 8 Social Housing Assessment 2017 8. Other property/land (please write in the following or tick where indicated) Do you or any member of the household own Yes No property or land in Ireland or any other country? (please tick) If so, does this include a residential property which is vacant? Yes No Address of the property or land owned (please write in) 9. Areas of Choice (area preferences for housing) Please update your ‘Areas of Choice’ by ticking the areas you are interested in, subject to the following rules : Every applicant must chose at least 1 area of choice, up to a maximum of 3 If you change your areas of choice, you will be deemed qualified for that area from the date you changed to this area and not from the date you originally qualified for social housing. Once you change your areas of choice you are committed to these areas for a period of 12 months Please state clearly using a tick which areas you want to be considered for. Limerick City East: Carew Park/Kincora Park Castleconnell Castletroy/Annacotty Old Cork Road Garryowen Southill Limerick City North Ballynanty Kileely Moyross Thomondgate St. Marys Parish St. Marys Park Caherdavin/Woodview Limerick City West Dooradoyle/Raheen Prospect/Ballinacurra Weston Patrickswell Watergate Innercity Limerick City and County Council, Merchant's
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