City Housing Eligibility
& Application
Name of Applicant:
Process
· Complete the application form.
· Attach the following documents: (Refer to page 3 for more details) Income Details
Proof of identification/residency Proof of housing costs
Proof of assets (eg bank statement) Other supporting documents if relevant Referral from health services
· Submit to City Housing by post or deliver to Civic Offices
· Your application form will be assessed and a credit check obtained by City Housing.
If eligible you will be invited to an interview where your housing need will be assessed. You are welcome to bring a member of your family, whanau, a friend, support agent or interpreter.
If ineligible you will be informed in writing.
Note: If documentation requested by City Housing is not supplied within one month your application will be cancelled.
Privacy Statement
Applicants should note that prior to a Christchurch City Council unit being allocated, they may be required to complete a Statutory Declaration concerning income and assets.
Pursuant to Principles 3 & 10 of the Privacy Act 1993:
1. The information is being collected to enable the Council to maintain its Rental Housing records. 2. The intended user and holder of the information is City Housing, Christchurch City Council.
3. You have the right of access to and correction of any personal information held about you by the Council. 4. The personal information is not required by law, however, if refused, the Council may decline your application. 5. Your personal information will not be shared with any Units of the Council not involved in
processing your application or attending to any matters relevant to your tenancy.
City Housing
ALF01
For Office Use Only
BP Number
Application Number
Date Received
Fast Entry Date
Date Approved/Declined
Applicant Eligibility
Residency Status
· New Zealand Residents
Immigrants granted Refugee Status
· Immigrants in possession of a NZ Residence Visa · Immigrants in possession of a NZ Residence Permit · Immigrants in possession of a Returning Residence Visa
Income
Assets
Asset levels for eligibility purposes are established at: Single person living alone: $28,408 Other: $42,670 Assets Include:
· All motor vehicles
· Prepaid funeral expenses in excess of $10,000 · Cash-in-hand in excess of $2,372
· Bank deposits
· Private Superannuation schemes · Bonus Bonds
· Family Trusts · Other investments · Boats
· Other items of value in excess of $3,558 per item · Real estate
Assets do not include furniture or personal effects.
Wait-list categorisation
Category A: Immediate housing needs: homelessness, current accommodation unsuitable or substandard, pending tenancy termination in less than 30 days.
Category B: Moderate housing need: current housing overcrowded, pending tenancy termination in 30 – 90 days. Category C: Low level housing need: applicants are eligible but do not meet the category A or B criteria.
Category D: Low level/no housing need: applicants are eligible however may be able to function in the private rental market.
Family Type Net Income after tax
Annual
Weekly
Single Person - living alone $28,621.32 $550.41
Other $44,032.56 $846.78
Most recent date entry stamps in passport to be more than two years old
Housing Needs Assessment
Affordability: Inability to afford housing in the private market based on housing costs :income
Income is net income which is assessed as income available after the deduction of Income Tax, Disability Allowance and other non taxable allowances.
Income: of combined applicants ( ref Income Status Criteria ) to be housed taken into account.
Adequacy: Takes into account the physical condition / structure of current accommodation e.g current accommodation presents a risk to the health and safety of the household.
Suitability: Suitability of current accommodation in terms of overcrowding – assessed on basis of number of bedrooms available: number of bedrooms required.
Accessibility: Based around discrimination experienced by the applicant/s and start up costs to access the private rental sector. Sustainability: The Ability to sustain housing in the private sector market
Has a proven need for housing
Location is currently not conducive to easy access to public transport services, shops, medical and other support services, relatives/ friends/ caregivers.
Current accommodation compatibility with special needs of applicants. Currently in temporary accommodation
Period of time for which current accommodation is available to the applicant/s. Current health factors.
Current personal safety factors.
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1. Income details (Please provide details of all sources of income)
For beneficiaries: An Income Statement (for the last 52 weeks) from Work and Income New Zealand. This can be obtained by phoning them on 0800 559 009.
You will receive this by post from Work & Income New Zealand.
For Wage/Salary earners: Please obtain this information from your employer by getting them to complete an income statement which is available by contacting 941 8999 or www.ccc.govt.nz
2. Proof of Identification / Residency
We require documented proof that you were either born in New Zealand or have been granted permanent residency to live in New Zealand. Proof can be:
a) A birth certificate b) A passport
c) A statutory declaration (obtainable from a Justice of the Peace/District Court)
Proof of residency is also required for all children living with you. This proof includes the above (a, b, c) or confirmation (including their date of birth) from Work and Income New Zealand.
3. Proof of housing costs
Confirmation of current housing costs can be : a) Your current Tenancy Agreement b) A letter from your current landlord
c) If boarding, a letter from the householder you board with.
4. Assets
a) Bank statements. Latest monthly bank statements for all accounts.
b) Solicitors letter (if you have had any interest in a property in the last five years)
5. A completed “Referral from Health Services/Agency Support” form. (See Page 6)
6. Other supporting documents if relevant:
· Doctors Certificate for Health Issues. · Tenancy Termination Letter.
· Supporting letters from support worker or Probation Officer. · Reference from previous/current landlord.
Unfortunately we are unable to progress your application unless
all the information requested is supplied.
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Applicant 1
Mrs/Miss/Ms/Mr Surname
First/Given names
Known as
Male Female
Date of birth / /
Place of birth
Age Nationality
Residency Status (e.g.NZ Citizen or other
(please specify)
What is your main source of income?
Employment Full-time
Part-time
Unemployment Benefit
(Income statement to be completed by employer)
Invalids Benefit Sickness Benefit Superannuation Domestic Purposes Benefit
Other (please specify)
What is your regular income after tax $
Weekly / Fortnightly
Other sources of income $
Weekly / Fortnightly
Marital Status
Single Married Partner
Number of people to be housed: No. of adults No. of children
NZ Resident
Names
M/ F Date of Birth
Relationship to you
Y
N
/ /
/ /
/ /
/ /
Please note: Residency status must be provided for new household members.
Current Address
Phone
(Home)
( Work )
(Mobile)
Preferred Mailing Address (if different from above)
Have you or the second applicant rented from City Housing before: Yes
No
If yes, please give the last address you rented from us
Combined take home income for your household?
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Applicant 2
Mrs/Miss/Ms/Mr Surname
First/Given names
Known as
Male Female
Date of birth / /
Place of birth
Age Nationality
Residency Status eg NZ Citizen or other
(please specify)
What is your relationship with Applicant 1? Married Partner Relative Friend
What is your main source of income?
Employment Full-time Part-time
Unemployment Benefit
(Income statement to be completed by employer)
Invalids Benefit Sickness Benefit Superannuation Domestic Purposes Benefit
Other
(please specify)
What is your regular income after tax $
Weekly / Fortnightly
Other sources of income $
Weekly / Fortnightly
Property Ownership
Please complete if you, your spouse/partner, or any one else named in this application own, or have owned,
property within the last 5 years.
Real estate currently owned
(in full or in part)
Address
Reasons for not living in the property
Real estate sold in the last 5 years
Address
Date sold / / Sale price $ Settlement you received $
Supporting documentation will be required to progress your application
Assets
Do you have any assets (including money in the bank, investments, shares, term deposits, bonds)?
Bank statements No Yes If yes, approximate value
(attach a copy)
Share statement No Yes If yes, approximate value
(attach a copy)
How many vehicles do you own?
Approximate value of each vehicle $
$ $
$
Other Asset Please specify
(eg Caravan, Boat)
Approx value $
Do you have a Case manager/Health worker who will be providing support?
Yes No If Yes,
Name
Organisation
Address
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IF APPLICABLE
Details of Agency Support
The following information is requested from the Agency which is going to offer support:
What are applicants housing needs (reasons for application).
Which Agency will be supporting the applicant during a City Housing Tenancy?
Who will be the main person to contact: (e.g. key worker, Case Manager, Community Support Worker)
Frequency of Contact / home visits? Or Type of contact?
Please identify any applicant’s needs and how these will be met. (e.g. budgeting, housekeeping, social support)
Any specific requirements? Please give details of work, social, leisure or other networks the applicant may be involved in and which would require accommodation in a particular area.
Reason for requesting this information:
City Housing is requesting this information in the context of its Tenant Support Policy:
“to ensure that tenant support is facilitated in order to assist City Housing tenants to live independently and achieve a good quality of life”
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Is there any additional information that would help us to meet the applicant’s needs:
Agency Signature Date
Pursuant to Principles 3 & 10 of the Privacy Act 1993
1. The information is being collected to enable the Council to maintain it’s Rental Housing records. 2. The intended user and holder of the information is City Housing, Christchurch City Council
3. You have the right of access to and correction of any personal information held about you by the Council 4. The personal information is not required by law, however, if refused, the council may decline your application. 5. Your personal information will not be shared with any units of the council who are not involved in
processing your application or attending to any matters relevant to your tenancy.
Disclosure by applicant:
If I accept a City Housing tenancy and City
Housing have real and justifiable concerns about my tenancy or well-being I give them permission to contact the following persons.
Case Manager / Key Person
Telephone Day-time After Hours And/or
Family Member / Whanau / Supportive Friend
Accommodation Needs
Please explain why you require accommodation with City Housing
Do you or anyone living in your household require any particular type of accommodation to assist with a disability? Yes No
If yes, reason why
Please list your preferred areas (suburbs) below:
Comments
I / we authorise City Housing, Christchurch City Council (or its agent) 1. To obtain, and any agency to disclose, a credit reference check
2. To disclose to a credit agency details of any indebtedness to City Housing 3. To obtain your forwarding address upon vacation of a City Housing property. I / we declare that the information contained in this application is true and correct.
I / we acknowledge the right of the Christchurch City Council to check the validity of the information
supplied with regard to my application and ongoing tenancy, including medical, social, and financial where applicable. If misleading or false, the application may be cancelled.
Applicant 1
Name (Please print clearly)
Signature Date / /
Applicant 2
Name (Please print clearly)
Signature Date / /
Number of bedrooms required Bedsit / Studio 1 Bedroom 1 Double Bedroom 2 Bedrooms
Other facilities required Garage Wheelchair access Off-street parking No stairs Preferred areas(suburbs) 1 2 3 4
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Civic Offices, 53 Hereford Street, Christchurch 8011. PO Box 73016, Christchurch 8154. Phone: 03 941 8999, Facsimilie: 03 941 8267, Email: [email protected], www.ccc.govt.nz ALF01