<p> ALT HOUSING CO-OPERATIVE</p><p>HOUSING APPLICATION</p><p>Housing Applications will not be considered unless a satisfactory reference is provided with the returned application form A copy of the Co-operatives lettings policy will be made available on request </p><p>ABOUT THE CO-OPERATIVE</p><p>Alt Co-operative is a fully mutual co-operative based in the Liverpool 8 District off Lodge Lane. All our 139 properties are within the Liverpool 8 area based in two streets and comprise 1 and mainly 2 bed terraced houses with only a few 3 bed houses Asbridge Street Ritson Street We are a non-profit making Registered Provider. Every tenant is required to be a member of the Co-op by purchasing a non-interest yielding share of £1.00. Every member has a right to have a say in how the Co-operative is run, and have voting rights in the decision making process. The Co-operative is controlled by its Committee of Management which is elected unpaid members who have been voted in at the Annual General Meeting of the Co-operative, by the majority of members attending. The Co-operative is registered society under the Co-operative and Communities Benefit Societies act 2014</p><p>THIS CO-OPERATIVE IS RUN FOR ITS MEMBERS, BY ITS MEMBERS & RELIES ON ITS MEMBERS INVOLVEMENT FOR ITS CONTINUED SUCCESS Please return completed application to: Co-operatives Agent - Northwest Housing Services 19 Devonshire Road, Liverpool, L8 3TX tel no 0151 726 2237 [email protected]</p><p>Page 1 of 10 HOUSING APPLICATION</p><p>About you and your household</p><p>National Insurance Sex Is this Is this number of adults who are Relation male person person to Surname First Name Date of Birth going to be re-housed to you or living be re- with you female with you housed now? with you? / / / / / / You</p><p>/ / / / / /</p><p>/ / / / / /</p><p>/ / / / / /</p><p>/ / / / / /</p><p>/ / / / / /</p><p>/ / / / / /</p><p>Current address and postcode </p><p> email address: </p><p>Phone Number Home: Work:</p><p>Mobile Number</p><p>How long have you lived here? (we need proof of this)</p><p>Can we contact you at your home address? Yes No</p><p>If ‘NO’, please give an address or phone number where we can contact you and when is the best time to contact you?</p><p>Is anybody on your application expecting a baby Yes No</p><p>If ‘YES’, please give the name of the person and the date the baby is due. (Proof required)</p><p>Page 2 of 10 Immigration Status</p><p>Is anybody on your application restricted by immigration rules Yes No</p><p>If ‘YES’, please give details </p><p>Income Details</p><p>Please tick the box that best describes you and your partner You Your Partner</p><p>Working full time (over 16 hours) Yes No</p><p>Working part time Yes No</p><p>Looking after children or someone sick or elderly Yes No</p><p>Looking for a job Yes No</p><p>Pensioner or retired Yes No</p><p>Long term sick or disabled Yes No</p><p>Not looking for work Yes No</p><p>Full time student Yes No</p><p>Government training scheme Yes No</p><p>Other (please give details) Yes No</p><p>Please tick the box that best applies to you and/or your partner. Do not include Child Benefit, Housing Benefit and Council Tax Benefit. Benefits You Your Partner</p><p>Income Support or Jobseeker’s Allowance or ESA Amount £ £</p><p>Wages/Employed (please give employers details below) Amount £ £</p><p>You Your Partner Address: Address:</p><p>Telephone Number Telephone Number </p><p>Working Families’ Tax Credit Yes No</p><p>Disability Living Allowance or Attendance Allowance Yes No</p><p>State retirement pension Yes No</p><p>Company pension Yes No</p><p>Other state benefits Yes No</p><p>Page 3 of 10 OtherPrevious (please Address/es give details) Yes No</p><p>Please list the previous address of all the adults you have included in your application for re-housing, for the last five years. Start with the address you live at now. We may use this information to get references from previous landlords.</p><p>Name Previous Address Dates from – to Landlord</p><p>Which of the following best describes your situation?</p><p>Please tick one box in each column:</p><p>Type of occupancy Type of accommodation</p><p>Council tenant House</p><p>Private tenant Maisonette</p><p>Living in property I own Flat</p><p>Housing association tenant Bed and Breakfast</p><p>Living with friends or relatives Hospital</p><p>Lodger Bungalow</p><p>Hospital or residential home Bedsit</p><p>In prison Caravan or mobile home</p><p>Accommodation with job Hostel</p><p>Member of armed forces Sheltered or supported housing</p><p>Other (Please give details) Other (Please give details)</p><p>Are you a tenant at your current home? Yes No</p><p>Are you an owner occupier at your current home? Yes No</p><p>Do you have an assured shorthold tenancy, a licence, or a Starter tenancy (e.g. six month, 12 month)?</p><p>How many bedrooms do you have 1 2 3 4 5</p><p>Page 4 of 10 Have you ever been evicted? Yes No If ‘YES’, give us the following information</p><p>The address you were evicted from</p><p>The landlord’s name</p><p>The reason you were evicted</p><p>The date you were evicted</p><p>Criminal Convictions</p><p>Have you, or anyone on your application, any criminal convictions for firearms offences or drug related offences? </p><p>If ‘YES’ please give details of the offences, including dates and sentences.</p><p>Health – disabilities or mental health </p><p>Please tell us if you or anybody else on your application is disabled or has a history of mental health </p><p>You Your partner Other people</p><p>Briefly describe the nature of your disability/mental health and provide relevant contacts for support services involved (all information provided is confidential)</p><p>Page 5 of 10 Reasons why you need re-housing</p><p>Tick the boxes that best describe why you need re-housing. (*Proof will be required) </p><p>Split up from partner To get children into a better school</p><p>Losing home with job* Neighbourhood problems</p><p>Landlord selling property* Health reasons*</p><p>Want to move to a better area Overcrowding</p><p>Victim of crime or fear of crime Building Society repossession*</p><p>Need a smaller property Asked to leave by friends or relatives</p><p>To leave home Cannot afford present housing</p><p>To be nearer friends and family Nearer current employment</p><p>Living apart from family To give support</p><p>Eviction order* To receive support</p><p>Poor condition of property Need a larger home</p><p>Other (Please give details)</p><p>Are you suffering from harassment or domestic violence (Proof required) Yes No (attach separate sheet giving details if necessary)</p><p>What type of housing would you consider? (please see attached information sheet for choices available for this Co-operative)</p><p>House Maisonette</p><p>Flat Bungalow</p><p>Bedsit</p><p>How many bedrooms do you need? 1 2 3 4 5</p><p>Please refer to the front cover of this application form. This provides details of availability of different types of homes.</p><p>Page 6 of 10 Please use area below to detail relevant additional information which may support your housing need </p><p>Page 7 of 10 Declaration</p><p>Are you Board Member or an employee of Northwest Housing Yes No Services – or related to or have connections with a Board Member of NWHS</p><p>If ‘YES’ give details</p><p>Are you related/or have any connection to a committee member of Yes No The Co-operative</p><p>If ‘YES’ give details</p><p>Data Protection Act We register the information you give us on your housing application form in line with the Data Protection Act. We may share the information with other landlords or ask for references from your previous landlords. It is important that the information you give us is accurate. We may use certain information on your form to check the accuracy with the department of Work and Pensions, Police, Probation and Social Services Liverpool City Council ( i.e.Supported Living and the Homelessness team)and other registered social landlords and private landlords or their agents.</p><p>In completing this form, you understand that in order to process your application we must share information you have provided with all the agencies identified mentioned within this application. All information which you have provided is processed in accordance with the Data Protection Act 1998 and the obligations which are placed on Data Controllers</p><p>Please Read & Sign the Declaration </p><p>As far as I know, the answers I have given on this form are true. I understand that I may lose any housing or tenancy if I have given false information. I understand that all the information I have given will be put on the landlord’s computer. I will tell the Co-op immediately if there is any change to the circumstances I have told you about in this form. I understand that by signing this declaration I am giving permission to contact any previous landlords and relevant agencies to check the information and release any relevant information. I agree to the information provided being shared with other housing agencies.</p><p>Your signature Date:</p><p>Your partners signature Date:</p><p>Please return your completed application form to:</p><p>Agents: NORTHWEST HOUSING SERVICES 19 Devonshire Road L8 3TX T 0151 726 2200 F 0151 726 2250 W www.nwhousing.org.uk Professional services to registered housing providers & the third sector</p><p>Customer led, ethicallyPage guided, 8 of 10 mutually owned Checklist</p><p>Proofs of Residence- we will require 2 proofs of residence for all adults listed and one proof for all children listed i.e. Child Tax Credit, if you are pregnant, you will need to provide a letter or a certificate from your doctor as proof. We will also require proof of National Insurance number – this information will be requested at the Home visit stage - DO NOT PROVIDE THIS INFORMATION WITH THIS APPLICATION</p><p>Some examples of proofs of National Insurance and residency we may need to see at interview stage:</p><p>Benefit Agency letter P60 Recent paid Utility Bill</p><p>Child Tax Credit National Insurance Card Medical Card</p><p>Wage Slip Bank Statement Driving License</p><p>Equal opportunities monitoring form</p><p>We are committed to fighting discrimination and inequality in our service to the public. To help us monitor the success of our equal opportunities policy, it would be helpful if you could fill in this form. If you do not wish to fill in this form, it will not affect your application. We will not pass on the information you give us to anyone else, and will only be used to monitor, develop and improve our housing policies.</p><p>Please tell us your Nationality/Country Your Other You Of Origin by ticking the relevant box Partner People</p><p>Asian</p><p>Caribbean</p><p>African</p><p>South East Asian</p><p>British European</p><p>Irish</p><p>Chinese</p><p>Yemeni</p><p>Travellers </p><p>Gypsies</p><p>Romanian </p><p>Polish </p><p>Other</p><p>Combination/Mixed race</p><p>Declined to answer</p><p>Your Other Only tick one box in each column You Partner People</p><p>Page 9 of 10 Black</p><p>White</p><p>Other</p><p>Mixed Race</p><p>If you think that the categories above are not applicable, you can use this space to tell us why.</p><p>Your Other Religion You Partner People</p><p>None</p><p>Hindu</p><p>Sikh</p><p>Christian (include Church of England, Catholic, Protestant And all other Christian denominations</p><p>Buddhist</p><p>Jewish</p><p>Muslim</p><p>Other</p><p>Prefer not to say</p><p>Thank you for your help. This information will help us make sure we run our services fairly- we may use information you have given on this form to analyse demand for our properties </p><p>Page 10 of 10</p>
Details
-
File Typepdf
-
Upload Time-
-
Content LanguagesEnglish
-
Upload UserAnonymous/Not logged-in
-
File Pages10 Page
-
File Size-