HOUSING APPLICATION FORM - Wokingham Borough Council

NAME
REG
OFFICE USE ONLY
HOUSING APPLICATION FORM
What type of Housing are you applying for (please tick):
General Housing
Sheltered Housing
Extra Care Housing
Supported Housing
Keyworker Housing
Please read this page very carefully before you complete the form.

Please do not complete this form if you are a tenant of Wokingham Borough Council or a
Housing Association - ask for a transfer application form (unless you are applying for Extra
Care housing).

Please complete every question on the form. If it is not applicable – write NOT APPLICABLE
in the space

Incomplete forms will be returned to you and will delay your application.

Please ensure you provide copies of all relevant documentation as requested
Before we can make you an offer of housing we may:

Undertake at least one home visit

Require evidence of current and previous addresses
If you or someone you know has difficulty reading this form you can
request a large print copy.
For Office Use Only – Input (initials) and Date
SECTION 1: PERSONAL DETAIL
DETAILS OF YOUR HOUSEHOLD:
Title
Surname
First Name
Sex (M/F)
Date of Birth
Applicant/s
Main Applicant
Joint Applicant
PEOPLE TO BE HOUSED WITH YOU:
Title
Surname
First Name
Sex
Date of
Relationship to you
(M/F)
Birth
(e.g. daughter/son)
If you are expecting a child please put your expected due date. Include a certificate of proof of pregnancy from your midwife/GP.
YOUR CURRENT ADDRESS:
POSTCODE
Home Tel. No
Work Tel. No
Mobile Tel. No
Failure to provide a current telephone number where you may be reached during the day may result in you losing offers of housing.
PARTNER’S ADDRESS IF
DIFFERENT:
TENURE (FAMILY HOME/OWNER
OCCUPIER/TENANT FOR EXAMPLE)
ETHNIC ORIGIN (please identify your household’s ethnic origin under a number of broad headings):
White
Asian or British Asian
21
British
28
Indian
22
Irish
29
Pakistani
4
Traveller of Irish Heritage
30
Bangladeshi
4
Gypsy/Roma
35
Chinese
Any other white background
31
Any other Asian background
23
Mixed
Black
24
White and Black Caribbean
32
Caribbean
25
White and Black African
33
African
26
White and Asian
34
Any other Black background
27
Any other mixed background
38
Any other ethnic background
WHERE YOU LIVED BEFORE - Please give all addresses for the past 7 years including the post code:
*Tenure: private rent/owner occupier/social housing tenant etc.
1
2
3
4
2
TENURE *
DATE TO MM/YY
DATE FROM MM/YY
Please complete this question if you or any member of your family is currently employed by the Armed Services
Please state the full address that you enlisted from:
How long were you resident at that address? From
To
When did you enlist?
Are you or anyone included in this application subject to immigration control?
Yes No
Name of Person/s
An asylum seeker (asylum seekers are not eligible to join)?
An EEA national?
A person who has limited leave to remain?
A person given leave to enter the UK for education or employment reasons?
Someone who normally resides outside the UK?
A person who has arrived in, or returned to the UK in the past 5 years?
Are you a citizen of (please tick):
Czech Republic
Bulgaria
Estonia
Hungary
Latvia
Lithuania
Signed
Poland
Romania
Slovakia
Slovenia
Date
If you answer YES to any of the above questions you will be required to provide evidence of your
immigration status and eligibility for an allocation of housing with this application form.
If you have recently arrived in the UK or returned from abroad in the past 5 years you may
be asked to provide proof of status with travel documents, Home Office documents or passport.
Anti Social Behaviour
Have you ever lost accommodation due to anti social behaviour?
YES
NO
YES
NO
If yes, please give details:
Rent Arrears
Have you ever lost accommodation due to rent arrears?
If yes, please give details:
3
SECTION 2: YOUR PRESENT HOME
When did you move in? (dd/mm/yy)
Current Property Type? (please tick one box)
House
Caravan
Bungalow
Hotel
Maisonette
Bed & Breakfast
Flat
Hostel
1st Floor Flat
Room only (house in multiple occupation)
Ground Floor/Basement Flat
Lodgings
Bedsit
Prison
Hospital
Street homeless
Mobile Home
Other - please give details
Who owns your current property (full name)?
If a private landlord, please provide the address of the landlord:
How many bedrooms are there?
Are you currently:
How many bedrooms do you have the use of?
YES
NO
YES
Renting from a Private Landlord
Living with Friends
Renting a Council Property
Living with Family
In temporary Council accommodation
Tied (e.g. with job)
Renting from a Housing Association
Her Majesty’s Forces
A Home Owner
Street Homeless or Roofless
NO
Sleeping arrangements for each room:
Name
Age
LIVING ROOM
1ST BEDROOM
2ND BEDROOM
3RD BEDROOM
4TH BEDROOM
4
Relationship to you
Double or Single Room
YES
NO
YES
Do you have a kitchen?
Do you have hot water?
Do you share a kitchen?
Do you share hot water?
Do you have a bathroom?
If you live in a flat, is it upstairs?
Do you share a bathroom?
If you live in a flat, is it in the basement?
Do you have a toilet?
Do you have a garden?
Do you share a toilet?
Do you have a lift?
Is the toilet outside?
Has your Property been adapted for you?
NO
If your property has been adapted, please give details:
Do you consider your home to be in disrepair? If so, please state why:
Should you wish to talk to Environmental Health about any concerns you have with disrepair at your home,
please contact them via the main Council number (0118) 974 6000
Pets
Do you have any pets?
YES
NO
If yes which pets do you have? _______________________________________________________
Please note:
Many of our properties are not suitable for pets. It is unlikely that permission would be granted for keeping a
dog in communal flats, bedsits or maisonettes (including sheltered housing).
Our Housing Association partners rarely allow pets in any properties. By owning a pet you could be
restricting the number of properties that can be offered to you.
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SECTION 3: HEALTH AND WELLBEING
Does anyone in your household have an enduring medical condition, disability or enduring
Yes
No
mental health illness which is made worse by your housing?
If yes, please give their full name, and details of the condition:
Do you have a Social Worker or any other professional working with you or your family?
Name
Department
Address
Telephone Number
Name
Department
Address
Telephone Number
Name
Department
Address
Telephone Number
Sheltered Accommodation
Would you like information on Sheltered Accommodation?
(This is available for those applicants aged 60 and over).
6
Yes
No
SECTION 4: YOUR INCOME AND YOUR PARTNER’S INCOME
Please ensure you answer all questions on this page to avoid your application being delayed.
Main Applicant
Joint Applicant
NATIONAL INSURANCE NUMBER
EMPLOYMENT DETAILS
Are you currently employed?
YES
Take home pay per month?
£
*BENEFIT ENTITLEMENT
Do you receive any benefits?
NO
YES
NO
£
Main Applicant
YES
NO
Joint Applicant
YES
NO
If YES, please write in below, the total amount your household receives per month
Attendance Allowance
£
Job Seekers Allowance
£
Carer’s Allowance
£
Maternity Allowance
£
Child Benefit
£
Personal Independent Payment
£
Child Tax Credit
£
Severe Disablement Allowance
£
Disability Living Allowance
£
War Disablement Benefit
£
Employment Support Allowance
£
War Widow’s Pension
£
Guardian’s Allowance
£
Widowed Parent’s Allowance
£
Housing Benefit
£
Working Tax Credit
£
Incapacity Benefit
£
Universal Credit
£
Income Support
£
Other (please detail below*)
£
Industrial Injuries Benefit
£
*
*PENSION DETAILS
Main Applicant
Do you receive a state pension?
YES
If yes, how much per month?
£
Do you receive an occupational pension?
YES
If yes, how much per month?
£
*SAVINGS DETAILS
YES
YES
If so, how much savings (total)?
£
*OTHER INCOME DETAILS
NO
YES
NO
£
NO
Joint Applicant
YES
NO
£
Main Applicant
YES
NO
Joint Applicant
YES
If so what is that income?
(example – child support or details of any
shares/dividends)
Amount received per month?
NO
£
Main Applicant
Do you have any savings?
Do you receive any other income?
NO
Joint Applicant
£
£
7
NO
Main Applicant
SECTION 5: HOUSING DETAILS
Do you hold a tenancy for any other property in
Joint Applicant
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
the UK or elsewhere?
If yes, please give the address including the
postcode
Have you ever held a Council or Housing
Association tenancy in the UK or elsewhere?
If yes, please give the address
Landlord Details (Name)
Dates to / from (dd/mm/yyyy)
Reason for leaving
Do you or have you ever owned a property in
the UK or abroad (including a mobile home)?
If yes, please give the full address, the date of
purchase and date of sale if sold.
Date purchased (dd/mm/yyyy)
Date sold (dd/mm/yyyy)
Amount sold for
£
£
If not sold, what is the approximate value of the property?
£
£
Have you have ever owned any other property,
YES
NO
YES
NO
UK or abroad (including a mobile home)?
If yes, please give the full address, the date of
purchase and date of sale if sold.
Date purchased (dd/mm/yyyy)
Date sold (dd/mm/yyyy)
Amount sold for
Do you have a claim or interest in any property
elsewhere (this includes a
2 nd
£
£
Yes
No
Yes
home whether in
the UK or abroad)? Please provide the address.
What is the approximate value of the property?
£
£
8
No
Where you want to live - Please tick all the areas you would consider:
Arborfield
Ruscombe
Twyford
Barkham
Hurst
Wargrave
Crowthorne
Shinfield
Whitley Wood
Earley
Sonning
Winnersh
Charvil
Spencers Wood
Woodley
Finchampstead
Swallowfield
Wokingham
Remenham
Three Mile Cross
Wokingham Without
IF YOU TICK AN AREA YOU ARE AGREEING TO RECEIVE AN OFFER IN ANY
PART OF THAT AREA.
Why do you need rehousing?
Do you work for Wokingham Borough Council or any Housing Association
YES
NO
Are you related to any member of Wokingham Borough Council or Housing
YES
NO
Association staff?
Name
Employer
Please list below, any persons you have given permission to make enquiries on your behalf (e.g. mother):
Name
Relationship to You
Address …………………………………………………………………………………………………………………
……………………………………………………………..Telephone Number……………………………………...
Name
Relationship to You
Address …………………………………………………………………………………………………………………
……………………………………………………………..Telephone Number……………………………………...
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Please provide copies the following to support your application for housing.
PROOF OF IDENTITY
and/or
✓
Passport (in full) per household member/ID Card
Full Birth Certificate per household member
Driving Licence (main applicant)
PROOF OF TENURE
and/or
Mortgage statement/Deeds for any owned property
Tenancy/Licence Agreement signed by all parties
If you are living with family or friends, provide 2 bills or letters with your name and address on*
PROOF OF RESIDENCY
and/or
PROOF OF INCOME
Council Tax Bill
2 bills/letters to your address with your name*
Wage slips (all applicants)
and/or
Benefit Entitlement Letter/s (main/joint applicants)
and/or
Pension Entitlement Letter/s (main/joint applicants)
Details of Savings (main/joint applicants)
Child Benefit letter (pages 1 and 2)
PROOF OF PREGNANCY
MatB1 certificate from your GP
OTHER
Please sign and date page 10
Please sign and date page 11
Extra Care Only
Power of Attorney
Extra Care Only
Extra Care Self-Assessment
Extra Care Only
Dementia Diagnosis
Extra Care Only
Care Plan

Do not send in original copies

If you do not provide the correct documentation, this will delay the processing of your application.

Please mark each copy with your name and address as it appears on the application form.

Please ensure you complete the form in full.
I hereby authorise Wokingham Borough Council to contact any Agency including my Doctor, Social Worker,
Probation Officer or any other organisation connected with my case. I understand that these enquiries are
required under the terms of the Housing Act 1996 (Part VI).
Signed (Applicant) ………………………………
Signed (Partner)...............................................
Date ……………………………………………...
Date ………………………………………………
WHEN COMPLETED PLEASE RETURN YOUR FORM TO:
WOKINGHAM BOROUGH COUNCIL
HOUSING NEEDS TEAM
PO BOX 154, SHUTE END
WOKINGHAM, BERKSHIRE
RG40 1WN
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DECLARATION – Section 171 of the 1996 Housing Act Part VI
Thank you for completing this Housing Application Form. You must now read and complete this declaration
otherwise we will not be able to process your application. Please remember to notify the Housing Needs team if
your circumstances change e.g. a member of your household moves out or you change your address for which you
must complete a change to circumstances form. Other changes include a change of telephone number, birth of a
baby for which a copy of the full birth certificate will be required.
SECTION 171 OF THE HOUSING ACT 1996 STATES IT IS AN OFFENCE FOR ANY PERSON, KNOWINGLY OR
RECKLESSLY TO MAKE A FALSE STATEMENT OR TO WITHOLD INFORMATION REQUESTED, WITH THE
INTENTION OF MISLEADING A LOCAL AUTHORITY FOR THE PURPOSE OF OBTAINING SOCIAL HOUSING.
THIS INCLUDES FAILURE BY THE APPLICANT TO NOTIFY THE AUTHORITY OF A CHANGE IN
CIRCUMSTANCE WHILST IT IS CONSIDERING AN APPLICATION. THE OFFENCE IS PUNISHABLE BY A FINE
UP TO LEVEL FIVE (CURRENTLY £5,000).

I understand that the information on this form is available to other departments within the Council including the
Anti-Fraud Team

I understand the information provided on this application form may, if appropriate, be given to other Housing
providers such as Housing Associations and other Local Authorities

I understand the information on this form may, if appropriate, be shared with other statutory or non statutory
agencies

I declare that the details given for the purpose of this application are correct

I declare that I/We have not withheld any information

I authorise the Council to make necessary enquiries to check information that has been given.

I have read, or had this document read to me and I understand and agree with the details

I confirm that the information I have given on this form is true and correct

I understand it is very important to let the Housing Needs Team know of any changes to circumstances as
mentioned above

I understand that if I give false information you may remove my application from the waiting list or if I have been
rehoused, my landlord may take court action to evict me from the property
Applicant 1
Applicant 2
Name
Name
Date
Date
Signature
Signature
DATA PROTECTION ACT 1998. All the information that you give us on this form will be stored on our
computer database and you may ask to see all the details held.
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