Transfer Application Form

Strictly mhs homes Transfer Application Form1.0 NOTE1.1 This form is for customers who wish to move to a different size or type of property, this may be due to a change in household occupants, or a medical reason. It is necessary to answer all questions fully so that an accurate banding can be applied. An incomplete form will result in a delay in assessing your application.1.2 Please complete all questions in BLOCK CAPITAL LETTERS.1.3 Dates should be provided as Day, Month and Year (eg; if your date of birth is 10th May 1960 then please write it as 10/05/60).1.4 Most of the questions ask for a Yes or No answer, and you should tick only one of the two boxes to indicate the correct answer.If you require help in completing this form, please call into mhs express, 115 High Street, Chatham, Kent, ME4 4DH, or the Broadside Office located in Leviathan Way, Chatham, Kent ME4 4LN. 1.5 Equal Opportunities Statement mhs homes is an equal opportunities landlord and all lettings are made in accordance with need and regardless of sex, marital status, race, ethnic origin or religion.1.6 Check! Have you read the Transfer Lettings Scheme booklet? If you have not you may find that you are not eligible to transfer and this application may be rejected.2.0 APPLICANT’S DETAILS(Mr.Mrs.Miss) Applicant’s ForenameApplicant’s SurnameApplicant’s Current AddressPostal CodeHome Telephone Number Work Telephone Number Mobile Telephone Number3.0 WHY ARE YOU SEEKING A TRANSFER? __________________6-3.001 06/14 4.0 HOUSEHOLD DETAILS (Give details of all persons living in household. If a joint tenant wishes to be a joint applicant, please enter ‘JOINT’ in the column entitled ‘Relationship to Tenant’.)Ethnic Origin Surname First Name Sex Date of Birth Relationship (see Codes (M or F) to Tenant A1 to W3 below) / / Tenant/ // // // // /This scheme is in operation for monitoring purposes only. To ensure our continued development of the Equal Opportunities Policy, all applicants for rehousing are asked to place a tick in the appropriate box below. Provision of the information is on a voluntary basis and will be held in confidence. Should you not provide it, your decision will not affect your application for rehousing.BLACK WHITECARIBBEAN ORIGIN B1 BRITISH W1AFRICAN ORIGIN B2 IRISH W2OTHER B3 OTHER W3OTHERASIAN MIXEDINDIAN ORIGIN A1 WHITE & BLACK CARIBBEAN M1PAKISTANI ORIGIN A2 WHITE & BLACK AFRICAN M2BANGLADESHI ORIGIN A3 WHITE & ASIAN M3OTHER A4 WHITE & OTHER M4CHINESECHINESE ORIGIN C1 OTHER ORIGIN C24.1 Are any members of your household pregnant? Yes  No  If “Yes”: Who? ______Expected date of birth? __4.2 Are any members of the family registered disabled? Yes  No If “Yes”: Who? ______4.3 Are any members of the family wheelchair users? Yes  No 6-3.001 06/14 If “Yes”: Who? ______5.0 MEDICAL INFORMATION 5.1 Medical InformationIf you have any serious medical or social problems which are aggravated by your present accommodation, give brief details here.____________________________________5.2 A Medical Assessment Form may be required to enable us to assess medical priority applications. Please indicate if you have a form or need us to send one out for you.5.3 Required  Not Required 6.0 PRESENT ACCOMMODATION6.1 Do you live in a - House/Flat/Maisonette/Bungalow? (delete as applicable)6.2 Do you live in a - Sheltered Scheme? Yes  No  6.3 If flat - floor level? - is a lift provided? 6.4 How many bedrooms in whole accommodation? 6.5 How many living rooms? 6.6 How many WC’s? 6.7 Are you sharing your bathroom facilities with another household? Yes  No 6.8 Have you access to a private garden? Yes  No 6.9 Please provide details of any adaptations in your current property.________________________6-3.001 06/14 7.0 TYPE OF PROPERTYCheck! You must ensure that you have chosen accommodation that is a type and size reasonably suitable to your present needs. mhs homes will only offer you accommodation based on your current housing need. 7.1 All Applicants 7.2 For elderly and disabled applicants onlyHouse/Flat/Maisonette Bungalow/Sheltered Accommodation/ Ground Floor Accommodation7.3 Minimum No of Bedrooms required: 7.4 Details of any Pets: Type of animal Number Check! If you have a dog, permission to keep a dog will NOT normally be given to tenants transferring to a property which does not have direct access to a private garden.8.0 CHOICE OF AREATo choose all CHATHAM areas, please tick this box Castle Road  Luton Village  Jenkins Dale Central Chatham  Princes Park  Ordnance Street Lordswood  White Road  Weedswood Palmerston Road  Wayfield  Melville Court Dock Road For all ROCHESTER areas Borstal  Maidstone Road  Troy Town Delce  St. Williams  Warren Wood Longley Road  Rochester Town  The Fort For all GILLINGHAM areas Central Gillingham  Twydall  North Rainham East Gillingham  South Gillingham  South Rainham North Gillingham 6-3.001 06/14 For all STROOD areas Allhallows  Darnley Road North  Cliffe and Cliffe Woods Chapter  Earl  High Halstow Chattenden  Halling  Hoo Cliffe Road  Frindsbury  Temple Isle of Grain  Cooling  Wainscott Darnley Road  Pickwick  Watling Street Cuxton  Stoke  Cedar Road Smith Street  North Street For all SHELTERED SCHEMES Downsland House  Sovereign Court  Marion Rogers Quickrells  Rookery Lodge Great Paul House  Greenfields Close  John Coopper House Rhodes House  Russell House  Sindal Shaw House Elizabeth House  Thorndike House  Yeoman House Kelly House  Longdown House  Snodhurst House Mimosa House  Shawstead House  Hallwood House Note!  There are properties built with grant funding that are subject to nominations agreements with Medway Council. These properties will be offered via Kent Homechoice and not offered for internal transfers.  Customers needing a 4+ bed property are also encouraged to apply to Kent Homechoice to increase their chances of moving to a larger property. Please note that this may not be with mhs homes.10.0 MUTUAL EXCHANGES Mutual Exchange ListHave you considered a mutual exchange? This can often be a quicker way for our customers to move and involves you swapping properties with another customer. They don’t even need to be an mhs homes tenant. (conditions apply, please ask for details).Would you like us to send you information about our mutual exchange scheme Yes  No Alternatively, you can gain further information and register at www.exchangelocata.org.uk or by visiting our offices. 6-3.001 06/14 11. General Information Please write below any other general information you may wish to make in support of your application. Enclose any supporting evidence. ______________________________________________________11.0 DECLARATIONAre you or is anyone else listed on this form employed by mhs homes? Yes  No If yes, please state name and position of employee(s) Are you or is anyone else listed on this form a board member or relative of a board member for mhs homes? Yes  No If yes, please state name of the board member(s) I/we declare that the information I/we have given is true and I/we undertake to notify mhs homes 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. I/we understand that if false information is provide, mhs homes may refuse to accept future applications.Applicant 1 Signed: Dated: Applicant 2 Signed: Dated: This form should be returned to: mhs homes, Broadside, Leviathan Way, Chatham, Kent ME4 4LLRegistered Name: mhs homes limited Registered Office: Broadside, Leviathan Way, Chatham, Kent, ME4 4LL Registered under: Industrial & Provident Societies Act 1965 (No.26688R) Place of Registration: England6-3.001 06/14

Transfer Application Form

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