Housing Transfer Application

For office use only Your Name ...... Your Address ...... Reference Number (if known) ...... Office Use. N.A. C.C.

HOUSING TRANSFER APPLICATION

This application form is for tenants of Slough Borough Council who wish to apply for a transfer. Please refer to the booklet Housing in Slough for more information about applying for a transfer and how homes are let. Before we can make you an offer of housing we will: • Undertake at least one home visit • Require you to provide proof of identity for everyone you have included on your application form. • Require evidence of current or previous addresses • Require a statement to show you have had a clear rent account for at least six months.

If you need help completing this form you can use the guide Housing in Slough or call into MyCouncil.

Please return this form and copies of any documents to:

Slough Borough Council, Housing Needs Section MyCouncil, Landmark Place, High Street, Slough SL1 1JL

or by hand to:

MyCouncil Landmark Place, High Street, Slough SL1 1JL 9am to 6.30pm Monday 9am to 5.30pm Tuesday, Wednesday, Friday 10am to 5.30pm Thursday 9am to 1.30pm Saturday

MyCouncil Cippenham, Cippenham Library, Elmshott Lane SL1 5RB 10am to 5pm and 1.45pm to 4.45pm Tuesday, Thursday, Friday

MyCouncil Britwell, Wentworth Avenue, Britwell SL2 2DS 9am to 5pm Monday to Friday

MyCouncil Langley, Langley Library, Trelawney Avenue, Langley SL3 7VF 9.30am to 5pm Tuesday to Friday

Designed and Printed by Slough Borough Council BH/5330/31-10-08/G 1 About You 19. Other information How many dogs or cats do you keep? Dogs Cats 1. Where do you live? Please tell us here anything else about your housing needs or choice of areas for housing

2. List everyone who normally lives with you Declarations and signatures 20. All information on this form is personal data which will be placed on computer and therefore subject Title Last NameFirst Name Relationship to you Date of Birth National Insurance No. For Office Use to the data Protection Act 1984. It will be held in confidence and may only be disclosed to those Applicant agencies concerned with this application or those you tell us we can share information with on your behalf. Joint tenant Please list below, any person you have given permission to make enquiries on your behalf.

Name Relationship to you Address Telephone number Organisation

21. Please indicate if this form was completed through an interpreter.

Name of interpreter Contact Address Telephone number

I declare that I have conveyed information regarding this application as correctly as possible.

Signature of interpreter Date

22. Declaration 3. Is anyone listed above pregnant? Yes No • I/we authorise Slough Borough Council to make any enquiries concerning this application If yes, give her name and expected date of birth. Please remember to inform us when the baby is born. • I/we declare that the information I/we have given is true and I/we undertake to notify the council of any change in my/our circumstances that may affect this application. • I/we understand my/our application or tenancy will be cancelled if I/we have deliberately withheld or falsified information. • Section 171 of the Housing Act 1996 makes it an offence for anyone to knowingly give false information or to withhold information and may lead to prosecution. 4. Are we able to contact you by: • This authority is under duty to protect the public funds it administers and to this end may use the information you have provided on this form within the authority for prevention and detection of fraud. It 4 Give contact details may also share this information with others bodies administering public funds solely for these proposes.

By mobile phone

By email Signed You Date By telephone at work

By telephone at home Your Partner Date

2 7 14. Waiting for 3 or 4 bedroom properties 5. What are your preferred languages for reading and speaking? Please tick (4) Homeseekers with 2 children both aged under 10 of opposite sex, can choose either 2 or 3 bedroom properties. Applicant Partner Please select 2 bedroom 3 bedroom Reading Speaking Reading Speaking

Homeseekers with 4 children, can select either 3 or 4 bedroom properties English Gujerati Please select 3 bedroom 4 bedroom Hindi

15. Choice of area Polish Punjabi Please tick (4) the boxes in the areas you would like to live. Urdu Or tick (4) this box if you wish to live anywhere in Slough Somali Slough North Slough South Slough East Welsh Britwell Stoke and Baylis Cippenham Green Upton The Village Cannot read Lower Britwell Wexham Cippenham Meadows St Marys Sutton Lane Large print Northborough Priory Cippenham Junction Kedermister Ditton Park Audio Tape Manor Park Haymill Chalvey Castleview Colnbrook Central Town Centre Foxborough Braille British Sign Language 16. Housing for people aged 50 and over Other Choose general needs and/or housing reserved for older people by ticking the boxes General Needs Housing (any age) 6. Monitoring Slough Borough Council is concerned that it gives all applicants and tenants equal treatment. To enable us to Older peoples housing (age over 50 years) check that everyone is treated fairly, please answer the questions below. This information is strictly confidential. What is your ethnic group? Supported housing schemes (age over 60 years) applicant partner applicant partner Allington Court Apsley House Armstrong House African Mixed White & Asian Brook House Calstock House Kennedy House Afro-Caribbean Mixed White & Black African Redwood House Seymour House African Black Ghanaian Mixed White & Black Caribbean Housing Association Sheltered Schemes African Black Nigerian Any Other Mixed Lilac Court Hanover Close Anchor Court African Somali White British African Zimbabwean White Irish Britwell Close Upton Black - Other White Other Hanover Housing Trust are opening two Extra Care schemes for persons aged 55 and over at Northampton Bangladeshi White English Place, Northampton Avenue and at The Pines in Wexham Road. The 1 and 2 bedroom flats are available for Indian White Scottish rent and for purchase. Pakistani White Welsh Tick this box if you wish to find out more information Sikh White Irish Traveller Asian Afghanistan White Croatian 17. Low cost Home Ownership schemes such as New Build HomeBuy (part buy/part rent) and Open Market Homebuy are available in Slough. Tick the box if you are interested or would like further information. Please Asian Iraqi White Polish make sure that you have completed question 9. The Housing in Slough booklet has more information. Asian Kurdish White Portuguese Low cost home ownership Asian Other (please state) White Romanian Cantonese Refused 18. Council and housing association tenants living in Slough can display details of their home and Chinese housing requirements on the Mutual Exchange Register. This register can be viewed by members of the general public. What is your sexuality? 4 Tick ( ) here to join the mutual exchange register and tell us if your property has: Bisexual Hetrosexual Other A garden Parking facilities Central heating Disability adaptions Gay Lesbian Refused

6 3 What is your religion? Reasons for wanting to move applicant partner applicant partner Christian Budhism 10. Moving because of overcrowding Hindu None Moving because needing a smaller home Jewish Other Tell us who uses each room for sleeping (see example on page 13 of Housing in Slough - A Guide to your Muslim Refused application) Sikh Name and age of those using each room for sleeping 7. Are you or your partner connected to Slough Borough Council as: Bedsit/studio an employee or relative of an employee Yes No Bedroom 1 a Borough Councillor or relative of a Councillor Yes No Bedroom 2 a People 1st board member or relative of a board member Yes No Bedroom 3 If yes, please give details Bedroom 4 Living room 1 Living room 2 8. Is anyone in the household registered disabled? Yes No 11. Moving for medical reasons Disability Registration Number We may ask you to complete an additional medical assessment form 9. Income What is the name of the person affected? Are you or your partner employed? Yes No You Your partner What is the medical condition? Occupation Employers name and address Why is your present home unsuitable?

Weekly income £ Weekly £ Weekly Date of employment Give the name and contact details of any health workers such as doctor, consultant or health visitor.

Are you or your partner on benefits? Yes No You Your partner Income Support £ Weekly £ Weekly 12. Moving for other reasons Job Seekers Allowance £ Weekly £ Weekly If you need to move for other reasons please give details and the name of your Housing Officer. Working Tax Credit £ Weekly £ Weekly Disability Living Allowance £ Weekly £ Weekly Servere Disability Allowance £ Weekly £ Weekly Incapacity Benefit £ Weekly £ Weekly Attendance Allowance £ Weekly £ Weekly Choosing your home Housing Benefit £ Weekly £ Weekly Please read the advice on choosing your home in the leaflet Housing in Slough before completing this Child Benefit £ Weekly £ Weekly section. Your choices here will affect how long you may have to wait. Carers Allowance £ Weekly £ Weekly Maternity Allowance £ Weekly £ Weekly 13. Which of these types of housing would you like to live? £ Weekly £ Weekly Tick in the boxes 4 to confirm your choices Do you or your partner get paid a pension? Yes No Tick the boxes 4 to tell us your choices You Your partner Occupation Pension £ Weekly £ Weekly Flat - ground floor Studio or bedsit Maisonette Retirement Pension £ Weekly £ Weekly Flat - first floor High rise flats up to 5th floor House Do you or your partner have savings in the bank, building society? Yes No Flats - second floor or above High rise flats above 5th floor Bungalow You Your partner Would you like to be considered for Housing Association accommodation? Yes No ££ 4 5 What is your religion? Reasons for wanting to move applicant partner applicant partner Christian Budhism 10. Moving because of overcrowding Hindu None Moving because needing a smaller home Jewish Other Tell us who uses each room for sleeping (see example on page 13 of Housing in Slough - A Guide to your Muslim Refused application) Sikh Name and age of those using each room for sleeping 7. Are you or your partner connected to Slough Borough Council as: Bedsit/studio an employee or relative of an employee Yes No Bedroom 1 a Borough Councillor or relative of a Councillor Yes No Bedroom 2 a People 1st board member or relative of a board member Yes No Bedroom 3 If yes, please give details Bedroom 4 Living room 1 Living room 2 8. Is anyone in the household registered disabled? Yes No 11. Moving for medical reasons Disability Registration Number We may ask you to complete an additional medical assessment form 9. Income What is the name of the person affected? Are you or your partner employed? Yes No You Your partner What is the medical condition? Occupation Employers name and address Why is your present home unsuitable?