Application for Housing
“OFFICE USE ONLY” App. DateApp. No
Please complete this form if you want to seek housing from the Council or a transfer from your current Council property. We assess your housing application in line with our Allocation Policy and you will be placed in a band which decides your priority on the
housing register. Ack. Date
Please return your completed form to Housing Services, Town Hall, Station Road, Clacton-on-Sea, Essex CO15 1SE.
If you would like help to complete this form, please call at the Housing Services Reception at the above address or telephone (01255) 686466.
Have you applied for housing before at a different address? Yes/No
Are you an existing tenant of Tendring District Council? Yes/No
Part 1 Details of you and your family
You Your partner
Surname: Surname:
Title: Mr/Mrs/Miss/Ms Title: Mr/Mrs/Miss/Ms
First name: First name:
Date of birth: Date of birth:
National Insurance No.: National Insurance No.:
Address:
Postcode:
Telephone No(s): Email address:
If you fail to provide a telephone number or email address your application may be delayed Tell us the name of everyone you want to be housed with you including yourself:
Surname Forenames Sex Date of birth Relationship to you
Eligibility
Have you come to live in the United Kingdom in the last 5 years? Yes/No
Are you seeking or did you seek asylum in the United Kingdom? Yes/No
If yes, has a decision been made on your asylum application? Yes/No
If you have answered ‘Yes’ to any of these questions, we will send you another form to complete. But please continue with this one.
Part 2 Address history
Day Month Year
What date did you move to your present accommodation?
How long have you lived in the Tendring district? years
If you live in another area, have you lived in the Tendring district in the past? Yes/No
l If you do not live in the Tendring district, do you have family who live in the area? Yes/No
Do you work in the Tendring district? Yes/No
If you have answered ‘Yes’ to any of these questions, we will write to you for more information. Which local authority area do you currently live in?
Please list below all previous addresses where you have lived in the last 5 years (attach a separate sheet if
necessary) Dates Addresses From month/year To month/year Tenure
(private rented, owned, council, housing association)
Have you been a tenant of any council or housing association? Yes/No
If Yes, please give the name of your landlord, the address of the property, the date you left and the reasons why you left:
Name of landlord
Address of property
Date your tenancy ended
Reasons for leaving
If we need more information, we will write to you.
Have you ever applied as homeless to this or any other council? Yes/No
Were you provided with accommodation by the council? Yes/No
Did the council accept that it had a duty to provide you with accommodation? Yes/No
Have you been given notice to leave your present home? Yes/No
If Yes, on what date must you leave?
Are you a member of HM Forces? Yes/No
If Yes, please state your expected date of discharge.
Are you currently serving a custodial sentence (such as in prison)? Yes/No
If Yes, please state your expected date of release.
Are you currently in hospital or residential care? Yes/No
If Yes, please state your expected date of discharge.
Part 3 Your present home
Type of tenure (please tick as appropriate)
Council Housing association
Owner occupier Private tenant
Living with family/friends Shared ownership
Other (please specify)
Type of tenancy (please tick as appropriate)
Assured shorthold Assured
Secure Tied occupation
Regulated Temporary council
Temporary housing association Living with family / friends
Other (please specify)
Renting your home Name of your landlord
Address of landlord
Telephone number
How much is your rent? £ Weekly
Monthly
If you receive Housing Benefit to help you with your rent,
how much do you get per week? £
Do you have rent arrears? Yes/No
If Yes, how much do you owe? £
Owning your home
Do you have a mortgage? Yes/No
If Yes, what are your monthly payments? £
Do you have any other secured loan on your home? Yes/No
If Yes, what are your monthly payments? £
Do you have arrears? Yes/No
If Yes, how much do you owe? Mortgage £
Secured loan £
If you have arrears, is your lender taking any action against you? Yes/No
What is the estimated value of your home? £
How much is outstanding on your mortgage or your secured loan? Mortgage £
Secured loan £
We may need to write to you for more information about your housing and financial situation. Where you live now
House If you live in a flat or maisonette, please state which floor
Bungalow Lower ground (basement)
Flat Ground
Bedsitter flat First
Maisonette Second
Sheltered accommodation Third
Bed and breakfast Other (please specify)
Holiday park
Other (please specify)
How many bedrooms are in the property?
How many bedrooms are available for you and your household?
Do you have your own garden? Yes/No
Do you have a communal garden? Yes/No
Do you have clothes-drying facilities? Yes/No
Do you have heating? Yes/No
If yes, what type of heating do you have? Gas
Electric
Solid fuel
Living room
Do you have a living room? Yes/No
Is it for the sole use of your family? Yes/No
Is it shared with other people? Yes/No How many people?
Bedrooms
Please list which members of your family sleep in each bedroom.
Bedroom 1 Bedroom 2
Bedroom 3 Bedroom 4
Please give the approximate size of each bedroom
Bedroom 1 ft by ft Bedroom 2 ft by ft
Bedroom 3 ft by ft Bedroom 4 ft by ft
Bedsitter flats
If you occupy a bedsitter flat, please give the overall size of your accommodation ft by ft
Do you have a separate kitchen? Yes/No
Do you have hot water? Yes/No
Do you have facilities for storing and preparing food? Yes/No
Do you share a kitchen? Yes/No With how many people?
Do you share a bathroom? Yes/No With how many people?
If you do not have a separate kitchen, are the following provided?
(a) A sink with hot & cold water and draining board Yes/No
(b) Space for an oven/cooker Yes/No
(c) Food preparation and storage facilities Yes/No
(d) Suitable floor covering Yes/No
Bathroom / Shower room
Do you have a bathroom or shower room? Yes/No
Do you have hot water? Yes/No
Do you share a bathroom / shower room with other people? Yes/No
If yes, how many people do you share with?
Toilet
Do you have a toilet? Yes/No
Is it for the sole use of your family? Yes/No
If you share a toilet, how many people do you share with?
PART 4 Your income
Please state how much you receive of the following benefits.
Income Support £ Retirement Pension £
Incapacity Benefit £ Disability £
Job Seeker’s Allowance £ Working Families Tax Credit £
Other (please specify)
If you have savings, how much do you have? £
If you or your partner are working, please state your income below.
You £ per Your partner £ per
How long have you worked for your current employer? Years
How long have you worked in the Tendring district? Years
Do you receive a private pension? Yes/No
PART 5 Medical, welfare and special needs
If your existing housing conditions are bad for you or a member of your household, we will take this into account.
Are housing conditions affecting your health? Yes/No
How many people in your household have medical problems that are made worse by your housing conditions?
We will send you separate forms about this, but please continue with this form. Welfare and special needs
Are you, or is anyone applying for housing with you, pregnant? Yes/No
If yes, what is the expected date of confinement?
Please tell us why you want a home with special features or facilities.
Tick one or more of the boxes to show the reasons that apply to you (or someone in your household)
Mental health problem Deaf or partially deaf
Physical disability On drug / alcohol rehabilitation
Older person who is frail At risk of domestic / other violence
Older person with physical disability Living with HIV/Aids
Older person with mental health problem Young person at risk/ leaving care
Age-related mental illness Learning disability
At risk of sexual abuse Degenerative or debilitating illness
(eg Parkinson’s disease, multiple sclerosis)
Behavioural problems
Blind or partially blind At risk of racial harassment / violence
If you have ticked any of the above boxes, we may need to write to you for more information.
If none of the above describes your situation, please state your needs in your own words below.
I need special housing because
Do you, or anyone in your household, need to use a wheelchair indoors? Yes/No
Do you, or anyone in the household, use a mobility scooter? Yes/No
TOWNS AND COUNTRY AREAS WITH HOUSING
PART 6 Areas you prefer
Please tell us which area you would move to. Tick as many boxes as possible.
Alresford Great Bromley Little Oakley
Ardleigh Great Holland Manningtree
Beaumont Great Oakley Mistley
Bradfield Harwich Ramsey
Brightlingsea Jaywick St Osyth
Clacton Kirby Cross Tendring
Dovercourt Kirby le Soken Thorrington
Elmstead Lawford Thorpe le Soken
Frating Little Bentley Walton on the Naze
Frinton Little Bromley Weeley
Great Bentley Little Clacton Wix
Wrabness
All areas considered
Housing need
To help us assess housing need in the district, please enter below your two preferred choice of area from the selections you have made above. Please state two preferred areas only.
PART 7 Type of accommodation you prefer
By ticking the boxes below, please show the type of accommodation you want.
You may tick more than one box.
a) PROPERTY TYPE b) NUMBER OF BEDROOMS
House
Bungalow Studio Flat
Flat One bedroom
Studio Flat Two bedrooms
Maisonette Three bedrooms
Warden assisted housing Four bedrooms
Extra care housing
c) If you have selected a flat or warden-assisted housing please tick the following boxes to show your choice of floors: Any floor Ground floor First floor Second floor Third floor
Would you accept a flat above ground floor if the property is served by a lift? Yes/No
Some flats in warden-assisted housing are studio flats.
Would you accept a studio flat in warden-assisted housing? Yes/No
PART 8 Housing associations
Housing associations are non-profit making bodies who let accommodation in much the same way as Councils. There are several housing associations in the council’s area and in the majority of cases, the council has nomination rights to their housing. Where it means earlier re-housing, the council will consider nominating you for a suitable property. The information we hold on you will be made available to a housing association if we nominate you to a one of their properties.
If you do not want your details shared with a housing association please tick the box. Ticking the box could reduce your chances of being offered accommodation.
PART 8A Low cost home ownership
Please tick in the box if you would like further information about low cost home ownership schemes in the district?
PART 9 Ethnic monitoring
We do not use information in this section to decide who receives an offer of accommodation. The information helps us to ensure that racial discrimination does not prevent households gaining access to Council
accommodation. Our aim is to ensure that everyone has equal access to housing based on needs, regardless of race, colour, nationality or ethnic origin.
Please choose one section from A to E and show your ethnic origin by ticking a box or, where appropriate, write in your cultural background in the box provided.
a) White b) Mixed
British English White and Black Caribbean
British Scottish White and Black African
British Welsh White and Asian
Irish
Any other white background (please write in) Any other mixed background (please write in)
c) Asian or Asian British d) Black or Black British
Asian British Black British
Asian English Black English
Asian Scottish Black Scottish
Asian Welsh Black Welsh
Indian Caribbean
Pakistani African
Bangladeshi
Any other Asian background (please write in) Any other black background (please write in)
e) Chinese or Chinese British f) Any Other Ethnic Background
Chinese British (Please write in)
Chinese English
Chinese Scottish
Chinese Welsh
PART 10 Other information
Please give your reasons for applying for housing. The information you give will be used to assess your application so please give as much information as you can.
Please use the blank pages at the back of the application if you need further space.
PART 11 Declaration
The Council is committed to a policy of treating all housing applicants equally and will consider applications for tenancies from anyone in the district, whatever their race, colour, nationality or ethnic origin, religion, sex, sexuality, physical disability, appearance or marital status.
I declare that to the best of my knowledge all information given to me on this form is correct.
Your authorisation to disclose information
I/We have applied to Tendring District Council for housing assistance under the terms of Part VI Housing Act 1996 (as amended).
I/We understand that the Council will make enquiries about my/our circumstances in order to verify the information I/we have provided.
I/We give permission to a representative of the Council to verify the information on my/our application, including any financial or medical details, under any or all of the following:
• Housing Act 1996 (as amended by Homelessness Act 2002) • Data Protection Act 1998
Signed: _______________________________________________________________________ (Applicant)
Signed: _______________________________________________________________________ (Partner)
Date: _________________________________________