PREVENTION OF HOMELESSNESS APPLICATION FORM Priority for “Prevention of Homelessness” is awarded at Silver level. A Silver priority pass will be issued to persons assessed by either Scottish Borders Council (SBC) or BHA as being threatened with homelessness. Examples of this include, but are not limited to: Relationship breakdown (non-BHA tenants) Living in an insecure tenancy such as tied accommodation or having a Short Assured Tenancy which is coming to an end within 2-6 months Having a relationship breakdown with parents or another occupant of the home Having financial difficulties in making rent or mortgage payments within the current home Is living in a mobile home (not static) In order to assess your Prevention of Homelessness Priority application, please complete form in full. APPLICATION: Homehunt Registration Number ___________________ Your Name ____________________________________________________________________________ Your Address ___________________________________________________________________________ Telephone: Home _________________ Work _________________ Mobile ________________________ Prevention of Homelessness Have you/are you had a relationship breakdown and are a non-BHA tenant? Yes No if Yes, please give details of your relationship __________________________________________ ________________________________________________________________________________ living in an insecure tenancy such as tied accommodation Yes No or having a Short Assured Tenancy which is coming to an end within 2-6 months? if “Yes”, please give details of your tenancy tenure _______________________________________ ________________________________________________________________________________ had a relationship breakdown with parents or another Yes No occupant of the home? if “Yes”, please give details of your relationship breakdown ________________________________ ________________________________________________________________________________ having financial difficulties in making rent or mortgage Yes No payments within the current home? if “Yes”, please give details of your financial situation ____________________________________ ________________________________________________________________________________ living in a mobile home (not static)? Yes No if “Yes”, please give details of your financial situation ____________________________________ ________________________________________________________________________________ Please sign here __________________________________ Date __________________________ I confirm that the information I have given is correct and that I have not supplied any false or misleading information, or withheld any relevant information. I agree to the use of this information in accordance with the data protection notice as stated in the ‘Berwickshire Housing Association Guide’ booklet. Note: You can list specific locations or tell us a wider area which you would consider. We may contact you to discuss suitable locations when assessing your priority. PLEASE TICK WHICH AREAS YOU WOULD LIKE YOUR PRIORITY TO COVER You must apply for ALL suitable properties in the areas chosen or your priority will be removed after six months (please see the BHA Guide Booklet for more information about your priority) Coldstream Area Duns Area Eyemouth Area Eyemouth Area (contd) Birgham Allanton Ayton Grantshouse Coldstream Chirnside Cockburnspath Hutton Eccles Cranshaws Coldingham Lower Burnmouth Gordon Duns Eyemouth Deanhead Paxton Greenlaw Gavinton Eyemouth Gunsgreen Reston Hume Longformacus Eyemouth Old Town St. Abbs Leitholm Preston Foulden Upper Burnmouth Swinton Westruther Whitsome Sheltered Housing Developments If you have indicated a sheltered Housing Requirement on your registration form, please tick to choose the Developments you wish your pass to apply to: Coldstream, Gowanlea Court Duns, Boston Court Eyemouth, Linkim Court .