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Housing Needs Register

User Guide
Application for housing

Welwyn Hatfield Community Housing Trust

How to apply for social housing within Welwyn Hatfield

Please fill in this form if you want to join our housing needs register, also known as the waiting list. Please answer all the questions on this form in block capitals using black ink.
IF YOU NEED HELP FILLING OUT THIS FORM OR IF YOU CANNOT PROVIDE ANY OF THE INFORMATION ASKED FOR, PLEASE CONTACT THE REGISTRATIONS TEAM, CONTACT DETAILS ARE AT THE BOTTOM OF THIS SHEET. THIS APPLICATION FORM WILL NOT BE PROCESSED UNLESS YOU PROVIDE ALL OF THE FOLLOWING FOR YOURSELF AND ANY PARTNER:1 form of photo identification for each applicant, with full name and date of birth such as driving licence, passport. 1 other form of identification eg birth certificate or marriage certificate, driving licence, immigration documents or proof of benefit for each applicant and adult child. Birth certificate for each child PLUS Child Benefit for each child. 1 recent proof of residency (not more than 3 months old) from your current address eg rent book, tenancy agreement, bank statement, proof of benefit, wage slips, council tax bill, utilities bill for each applicant and adult child. If you have contact with children we need written confirmation of this for each child such as a copy of a court order or letter from the childs main carer. If you are a tenant in private rented accommodation we need to see your tenancy agreement. We also need proof of income for each applicant, such as wage slip, benefit letter. Please note that bank statements, wage slips and any other documentation should have been issued in the last three months. Please do not send original documents to us. However, you may be required to provide original documents at a later date if we offer you a tenancy. This form will be returned if supporting documents are not supplied. Should you have any questions about the form please contact Welwyn Hatfield Community Housing Trust Registrations Team Housing Office 51 Bridge Road East Welwyn Garden City AL17 1JR Tel: 01707 357686 Email: housingneedsadmin@welhat-cht.org.uk

If you are posting this appliction form please ensure it has the correct postage otherwise the Post Office will return your application to you and we will not receive it.

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1. Applicant Details
Personal Details
Title First Name Surname Male/Female Date of Birth National Insurance number If you are known by any other name, please state Applicant Joint Applicant Applicant Joint Applicant

Current Address

Postcode Date moved in Correspondence Address (Please tell us why we cannot write to you at your current address) Postcode

Contact
Home telephone number Work telephone number Mobile number Email address

Applicant

Joint Applicant

Please state how you would like us to contact you (you can tick more than one box): Email Face to face Text message Phone Post

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Please tick the box that applies to you: Single Living together Married Separated Widowed Divorced

If you have answered that you are married or divorced, please enclose proof (either a copy of marriage certificate or divorce absolute papers). Please tell us all the names you have previously been known by (including your maiden name if you are married)

Have you or your partner applied to join the housing needs register before? Yes. No If YES, when did you apply? And what name and address did you use (if different from where you live now)?

Have you ever been excluded from the Housing Needs Register of this Local Authority or any other Council or Housing Association? Yes No If YES, please give details.

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2. People who live with you

Please tell us about all the people who are currently living with you. Please show if you want them to be housed with you or not. Title First Name Surname Male/ Female Date of birth Relationship to applicant To be housed with you Y/N? Which bedroom do they use?

If you have children who permanently live with you tell us which schools they attend:

If any of the people you are applying to be housed with are not currently living with you please tell us who they are and where they live. First Names Surname Relationship to you Address

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Do you have contact with or arrangements for children under 16 who do not permanently live with you? Yes No If YES, please tell us the childs/childrens name(s) and date of birth and contact details of the main carer. We also need a copy of each childs birth certificate and a copy of a Court Order if you have one. Court Orders may include a Contact Order, Joint Residence Order, Care Order or Special Guardianship Order. If you do not have a Court Order we will need written confirmation of the contact arrangements from the childs main carer.

Name

Date of Birth

Contact details of main carer

Why you live apart

Please note that contact arrangements for children does not mean they are part of the household to be re-housed with you.
Are any members of the household pregnant? Yes No If YES, who When is the baby due?

We will need a Mat B1, once issued, as proof of pregnancy.

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3. Your immigration status: Main Applicant

ALL APPLICANTS MUST COMPLETE THIS SECTION.
Are you a UK Citizen Are you a EU Citizen If YES, please state of which country If you answered no to both the above what is your nationality Yes Yes No No

Are you or anyone on your application subject to immigration control as a result of the Asylum and Immigration Act 1996? Yes No If YES, please give details below and provide a copy of your passport and any other relevant documentation

Please state your Home Office Reference Number: Are you or is anyone on your application from one of the following countries and have entered the UK since 1st May 2004 (please tick)? Bulgaria Estonia Slovenia Poland Latvia Hungary Romania Slovakia Lithuania Czech Republic

If YES, please indicate whether you are registered for work with the Home Office? Yes No If YES, please provide a complete copy of your most recent Workers Registration document.

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4. Your immigration status: Joint Applicant

ALL APPLICANTS MUST COMPLETE THIS SECTION.
Are you a UK Citizen Are you a EU Citizen If YES, please state of which country If you answered no to both the above what is your nationality Yes Yes No No

Are you or anyone on your application subject to immigration control as a result of the Asylum and Immigration Act 1996? Yes No If YES, please give details below and please provide a copy of your passport and any other relevant documentation

Please state your Home Office Reference Number: Are you or is anyone on your application from one of the following countries and have entered the UK since 1st May 2004 (please tick)? Bulgaria Estonia Slovenia Poland Latvia Hungary Romania Slovakia Lithuania Czech Republic

If YES, please indicate whether you are registered for work with the Home Office? Yes No If YES, please provide a complete copy of your most recent Workers Registration document.

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5. Your present home

Please tick the box that describes where you live now House Bungalow Other (please state) Maisonette Mobile home Flat Caravan Bedsit

How many bedrooms are in your current home? If you live in a flat, maisonette or bedsit, which floor is it on? Ground Other (please tell us) First

Is your home due to be demolished or redeveloped? Yes No Is your home subject to a Compulsory Purchase Order? Yes No If YES to either of the above, please give details.

Do you have any adaptations or support in your home that you do not need anymore? Yes No If YES, please give details

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Please give further details about your home by ticking the boxes below Rooms which only you and those seeking accommodation with you use WC Bathroom/Shower Kitchen Living Room 1 Sleeping in Lounge Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 We will assume the applicant has the use of kitchen, W/C or bathroom if the property has the facilities installed. Rooms which you share with others who you do not require to be housed with you

6. Local Connection
Please list below everywhere that you have lived in the last seven (7) years. Start with where you live now. If you need more space use another sheet of paper and sign it. For each address, please tell us whether you lived there as a tenant, an owner occupier, living with parents, relations or friends, and so on. In what capacity did you live there?
For example; Council Tenant/ Owner Occupier/ Housing Assoc./ Private Tenancy

Address

When did When did you move you move in? out?

If you are/were the tenant, please give the name and address of the landlord

What was the reason for leaving?

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Please list everywhere the joint applicant has lived during the last seven(7) years, if different from your own. (Start with where they live now). In what capacity did you live there?
For example; Council Tenant/ Owner Occupier/ Housing Assoc./ Private Tenancy

Address

When did you move in?

When did you move out?

If you are/were the tenant, please give the name and address of the landlord

What was the reason for leaving?

Do you have a close relative, such as a parent or adult child, brother or sister currently living in the borough? Yes No If YES, please give details below Name Address Relationship to you Telephone number Date moved into Borough

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7. Prison
Are you applying from Prison? Yes No If YES, please give name/address/telephone number of probation, resettlement or support worker.

Expected date of release

8. Students
Are you or your partner a full time student? Yes No If YES, where do you or your partner study?

9. Armed Forces Personnel

If you or your partner are serving in the Armed Forces, did either of you live in the Welwyn Hatfield Borough for any three year period before you joined? Yes No If YES, please tell us your address and the dates you lived there:

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9. Employment
If you or your partner work please give us the following information: Applicant Job Title Is the work temporary or permanent?
(please delete as appropriate)

Joint Applicant

Temporary / Permanent

Temporary / Permanent

How many hours a week do you work? What date did you start? Employers name

Employers address

Address of place of work if different from the above

Employers telephone number

Description of duties

If you or your partner do not work, please give details of your most recent employer Recent Employers name

Recent Employers address

Reason for Leaving

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10. Medical Factors

Please ask for a Medical Form if you wish to be assessed under this section.
If you or any member(s) of your household have a special housing need or medical condition which makes your present housing circumstances unsuitable, please tick the appropriate box which best describes it. (You may tick more than one box). Physical disability Learning disability Mental health factors Any other health issue Name of Social or Health Worker, if you have one:

Please describe how this illness or disability is affected by your accommodation and explain if there are any special facilities you need eg wheelchair access etc.

11. Support Needs

Do you receive any help from Social Services or Health Services, for example social worker, hospital worker, district nurse, therapist, drug and alcohol services? Yes No If you have a named support worker, please give their details Name, address, telephone number

Please give details of the help you receive

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Please tick any of the boxes below if you need help or support because of any of the following issues: Disabled Isolated no support Issue with reading and/or writing Visual impairment Mental health issues Age related mental infirmity Ex offender Issue with drug misuse English is not my first language Permanent physical disability Learning disability May need help bidding and has no-one to help Hearing impairment Age related physical infirmity Young person leaving care Issue with alcohol Experiencing domestic violence Any other (Please state)..................................

12. Financial Circumstances

Income
Please provide proof of all income you receive, for example any benefits, salary and/or pensions. Please note that bank statements, wage slips and any other documentation should have been issued in the last three months:

Weekly (before tax/NI) Applicant State Benefits

(do not enter child benefit and housing benefit here. Include any state pension and job seeker allowance)

Joint applicant

Child Tax Credits paid to the person responsible for the child/children
(this is not child benefit)

Occupational/Stakeholder Pension Earnings from employment/self employment Working Tax Credit Housing Benefit Child Benefit
(exclude any childcare element)

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Savings and Investments

Do you or anybody included in your application have any savings and/or investments? Yes No Please give details of savings that you have: Name of Bank, Building Society, Post Office etc Applicant Capital Sum

Other household member

Property / Ownership UK & Abroad

Do you or anybody included in your application currently own or have shared-ownership of a property in the UK and/or abroad? Yes No Have you or anybody included in your application ever owned or had shared-ownership of a property in the UK and/or abroad? Yes No If you answered YES to either of these questions, please complete the following questions. If you answered NO please go to Section 13. Address of current or last property wholly or partly owned in the UK or Abroad, by either yourself or anybody included in your application.

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Date of Purchase Date of sale or date given up (if applicable) Type of property for example, house, maisonette, flat, bedsit, bungalow How many bedrooms does/did the property have? Is/was the property your only home? Yes No If NO, please explain

If the property is/was being purchased on a mortgage, is/was it in your sole name? Yes No If NO, please give the name(s) of the other purchasers and their relationship to you: Names Relationship to you

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If there is a mortgage outstanding, how much is this? Please provide a copy of your most recent mortgage statement. If the property has not been sold, what is its current value? If the property has been sold, how much did you personally receive from the sale after the mortgage and fees had been paid?

Please provide written evidence of this (such as a copy of the completion statement from your solicitor)
Other comments: Please include here any circumstances you consider to be relevant, for example if the sale was a result of relationship breakdown or a Court Order or if you have owned more than one property in the past, please give details including address:

13. Other Housing Options

Are you interested in part renting and part buying a home? (Also known as equity share or shared-ownership) Yes No Lea Valley Homes also keep a register of people who may be interested in purchasing an affordable home in Hertfordshire. If you need more information about this see their website www.leavalleyhomes.co.uk or telephone them on 01582 869440.

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14. Other information

Please use this space to tell us anything else you think might be relevant

15. Homeless Section

Do you think you might be homeless within the next 28 days? Yes No If YES , please give some brief details :

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16. Declaration
Have you or a member of your household ever been convicted of a criminal offence? Yes No If YES, please give details in the box below including the nature of the offence(s) and the date(s) of the conviction(s):

Are you or is anyone on your application a Local Authority Councillor or Council/Housing Association employee or member of a Tenants Panel? Or, are you or anyone on your application related to or have a close connection to a Local Authority Councillor, Council/Housing Association employee or a Tenants Panel member? Yes No If YES, please give details below

We ask this question because we want to ensure that we treat every applicant fairly.

17. Data Protection Information

We will control the information you have given us on this application form under the data protection legislation. All the information provided in this application form is held on a computerised database and is used to assist us in assessing your eligibility for re-housing. It is then used to help your potential landlord to re-house you in an appropriate home, and to supply and manage services. All relevant information will be passed on to the appropriate housing provider and any agency that will provide housing related support. Through the Herts Choice Homes Scheme, any landlord with whom you bid for a property will have access to your full application form should you be short listed for the property. Under the terms of the Data Protection Act 1998, you are still entitled to a copy of the information we hold. However, we may need to get permission from other people who gave us information before we can release it. If you have any questions regarding Data Protection and your application, contact us on 01707 357686.

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Please read this declaration carefully before you sign it

I/we understand that to knowingly give false information or to withhold information is an offence and that a person found guilty of this offence may face a fine. I/we understand that if I/we give any false or misleading information my/our application may be cancelled, or if I/ we have already been re-housed my landlord can prosecute me and take possession proceedings. I/we give you permission to check the information given on this form and to make any necessary enquiries to confirm the information, or to obtain further related information (including contacting present and previous landlords, employers, doctors, the Home Office, Social Services or any other relevant agency). This may also include making enquiries with a credit checking agency and Land Registry. I/we confirm that I/we have read, or have been read, the above section regarding Data Protection and understand that you can store any information I/we have given on this form on your computer and this may be seen by any housing association or agency that offers homes to people on the housing needs register. I/we understand the information may be checked with other data held by the Council and/or Welwyn Hatfield Community Housing Trust may be disclosed for other purposes under the control of the Council and/or Welwyn Hatfield Community Housing Trust as described in the data protection registry entry (Data Protection Act 1998), including the prevention and detection of fraud. I/we agree to keep you informed of any change of circumstances in relation to my/our situation, household and housing. I/we agree that if the Council and/or Welwyn Hatfield Community Housing Trust provide accommodation via a registered social landlord or private landlord and I/we move home, the Council and/or Welwyn Hatfield Community Housing Trust may pass on my/our new address to the registered social landlord or private landlord.

Signature: (Applicant)

Todays date:

Signature: (Joint applicant)

Todays date:

Should you wish to give permission for someone else to discuss your application please give details below. Name: Address:

Telephone Number: Relationship to you:

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17. Equality
We want to make sure our services are available to the people that need them, whatever their race, colour or national origin. The information you give here will help us do this. What you tell us will not affect your housing application and you do not have to give us this information. Applicant A White British Irish Any other White background B Mixed White & Black Caribbean White and Black African White and Asian Any other Mixed background C Asian or Asian British Indian Pakistani Bangladeshi Any other Asian background D Black or Black British Caribbean African Any other Black background F Gypsy/Romany/Irish Traveller E Chinese or other ethnic group Chinese Any other Joint Applicant

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17. Equality continued

We want to make sure our services are available to the people that need them, whatever their race, colour or national origin. The information you give here will help us do this. What you tell us will not affect your housing application and you do not have to give us this information. Applicant Sexual Orientation Bisexual Heterosexual Homosexual Do not wish to answer Religion Bahai Buddhist Christian Hindu Jain Jewish Muslim Sikh Zoroastrian Other None Do not wish to answer Joint Applicant

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Please send this form to one of the offices below with all documents required Housing Services Welwyn Hatfield Community Housing Trust 51 Bridge Road East WELWYN GARDEN CITY Herts AL7 1JR Housing Services Welwyn Hatfield Community Housing Trust 30/32 The Town Centre HATFIELD Herts AL10 0LD

FOR WELWYN HATFIELD COMMUNITY HOUSING TRUST USE ONLY Please contact your local housing office if you need more information.
Tenancy ref: Tenancy start date:

Date information requested:

Date information requested:

Registration Number:

Homeless Number:

Band:

Date Stamp / Date of application:

Notes:

Working in Partnership with Welwyn Hatfield Borough Council

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