HOMECHOICE APPLICATION FORM
 
 

An application is for the use of the landlords only and does not bind the landlords to make any offer of accommodation or the applicant to accept any offer made.

The tenant has security of tenure as an assured tenant so long as he/she occupies the premises as his/her only or principal home.

The landlords reserve the right to refuse access to its register and/or accommodation. This will be where it is in the landlords reasonable opinion that if the household was granted a tenancy he/her/they would be like to :-

  1. Persistently fail to pay rent.
  2. Cause directly, or indirectly, nuisance or annoyance to other persons in the community.
  3. Significantly affect the ability of the landlord to effectively manage the accommodation or sustain the community.
  4. Cause damage to the property and or neighbouring homes.

Judgement for exclusion from a property/tenancy will be made on an individual basis. Note- Transfer Applicants Tenants will a 'Secure Tenancy' will need to contact their own landlord about any restrictions on transfers to properties with 'Assured Tenancies'. Data Protection Act All Personal information will be handled in confidence, be entered onto our computer system and will comply with the Data Protection act 1998.

  PERSONAL DETAILS
   
 
  TITLE
Mr   Mrs   Miss   Ms   		TITLE
Mr   Mrs   Miss   Ms  
  SURNAME
 SURNAME
  FORENAME(S)
 FORENAME(S)
  DATE OF BIRTH
19 		DATE OF BIRTH
19
  CURRENT ADDRESS



CURRENT ADDRESS



  POSTCODE
 POSTCODE
  TELEPHONE NUMBER
 TELEPHONE NUMBER
  EMAIL ADDRESS

EMAIL ADDRESS
 


EMPLOYMENT DETAIL


EMPLOYEMNT DETAIL
  PLEASE IDENTIFY YOUR HOUSEHOLD'S ETHNIC ORIGIN
Asian Carribbean African South East Asian British/European Irish Other Combination Question Refused
 

PLEASE TELL US ABOUT YOUR HOME, ARE YOU
Owner/Occupier

Renting PLEASE STATE LANDLORD

Other PLEASE STATE

   
  PREVIOUS ADDRESSES
   
 
 
ADDRESS
LANDLORD
FROM DD/MM/YY
TO
DD/MM/YY
 
 
 
 
 
   
  PEOPLE WHO YOU LIVE WITH
   
 
 
TITLE
SURNAME
NAME
DATE OF BIRTH
SEX
 
Male Female
 
Male Female
 
Male Female
 
Male Female
 
Male Female
   
  ADDTIONAL INFORMATION
   
 
  DETAILS OF DISABILITY: (ONLY APPLICABLE WHEN APPLYING FOR 'ADAPTED PROPERTIES
 
  HAVE YOU BEEN CONVICTED OF A CRIMINAL OFFENCE IN THE LAST 2 YEARS ? No Yes
  IF YES PLEASE GIVE DETAIL BELOW  
 
  IF YOU HAVE BEEN SERVED A NOTICE TO LEAVE YOUR HOME, OR HAVE ANY RENT ARREARS, PLEASE GIVE FULL DETAILS BELOW.
(IF YOU HAVE PROOF, PLEASE ATTACH COPPIES TO THIS FORM)
 
  ARE YOU A MEMBER OF A HOUSING ASSOCIATION'S, OR MANSFIELD DISTRICT COUNCIL'S STAFF OR BOARD OF MANAGEMENT, OR ARE YOU RELATED TO SOMEONE WHO IS ?
 Yes No 
  IF YES, PLEASE GIVE DETAILS BELOW
 
   
  PLEASE READ THE FOLLOWING CAREFULLY
   
 
 

I/WE UNDERSTAND THAT THIS APPLICATION IS FOR THE USE OF THE LANDLORDS ONLY AND DOES NOT BIND THE LANDLORDS TO MAKE ANY OFFER OF ACCOMMONDATION OR THE APPLICANT TO ACCEPT ANY OFFER MADE.

I/WE AUTHORISE THE LANDLORD TO MAKE ANY ENQUIRES NESSARY TO SUPPORT MY/OUR APPLICATION.

I/WE ALSO CERTIFY THAT ALL THE DETAILS GIVEN ON THIS FORM ARE CORRECT AND COMPLETE TO THE BEST OF MY/OUR KNOWLEDGE AND I/WE UNDERTAKE TO INFORM THE LANDLORD OF ANY CHANGES.

I/WE UNDERSTAND THAT THE LANDLORD HAS THE RIGHT TO CANCEL MY/OUR APPLICATION, OR TO TAKE ACTION TO REPOSSESS ANY PROPERTY I/WE OBTAIN BY DELIBERATELY GIVING FALSE INFORMATION,

ALL PERSONAL INFORMATION WILL BE HANDLED IN THE STRICTEST CONFIDENCE, BE ENTERED ONTO OUR COMPUTER SYSTEMS AND WILL COMPLY WITH THE DATA PROTECTION ACT 1998.

 
  APPLICANT ONE SIGNATURE
DATE DD/MM/YY
  APPLICANT TWO SIGNATURE
DATE DD/MM/YY