REGISTRATION FORM.

Homes4U is also used to help the Council plan for new affordable homes; what types of homes are needed and where. It is important that if you think you may need affordable housing, now or in the near future, you are signed up to the scheme.

This document is available in large print and other formats on request.

Cewch y ddogfen hon mewn print bras a fformatiau eraill drwy holi.

If you have any questions about HOMES4Uor this application form please call the HOMES4U

Hotline on 01446 709840.

If you do not complete all sections, this will result in your application being delayed.

You must fill in all the sections of the form as honestly and accurately as possible, as this is a legal document, and sign the declaration on page 19.

• Homes4U is used to allocate new-build homes; priority for these homes if often given to people with a local connection to the area.

• Properties include houses, flats and properties designated for older people, such as sheltered housing.

• Homes are available across the Vale, in towns and rural areas.

• The rented properties available are mainly social rented properties, but can also include ‘intermediate’ rented properties which are more affordable than private renting.

Homes4U is the Choice Based Lettings Scheme the Council and local Housing Associations use to allocate rented housing. To be considered for these properties you have to be registered with Homes4U and then ‘bid’ for properties in areas that you want to live in.

Filling in the form:

Membership Number Registration Date Band / Group Reference Number Bedrooms Required Property Type

Reason Initial

Original Banding

Referred to Homeless Department

FOR OFFICE USE ONLY

Marital status: Forename: Surname:

Any other name used: Date of birth:

National Insurance No. Email address: Mr / Mrs / Miss / Ms / Other Lead Applicant Mr / Mrs / Miss / Ms / Other Joint Applicant

1. Applicant(s) details:

About you and your household

Home: Work: Mobile: Preferred contact number

Relationship to Lead Applicant:

Is this a joint application?

How would you prefer that we contact you about your application?

Yes No

Email Phone

Post What is your language preference?

Welsh English

Title: Forename: Surname:

Any other name used: Date of Birth:

National Insurance No. Lives at applicant’s address: If No, please state address:

Mr / Mrs / Miss / Ms / Other

About you and your household (continued)

2. Who else would be living with you?

(not including yourself or the second person included in the table above. You must

include details of everybody you wish to be housed with you, including children and

dependents.)

Relationship to Applicant: Access_only

Yes No

Yes No

Title: Forename: Surname:

Any other name used: Date of Birth:

National Insurance No. Lives at applicant’s address: If No, please state address:

Mr / Mrs / Miss / Ms / Other

Relationship to Applicant: Access_only

Yes No

Yes No

3. Are you, or anyone that you wish to be

housed with, pregnant?

If yes, please tell us who?

If you or someone you wish to be housed with is pregnant please provide proof of pregnancy. This is required in order for your application to be given the correct priority status.

Please continue on page 20 if necessary

Title: Forename: Surname:

Any other name used: Date of Birth:

National Insurance No. Lives at applicant’s address: If No, please state address:

Mr / Mrs / Miss / Ms / Other

Relationship to Applicant: Access_only

Yes No

4. Lead Applicant’s current address

About you and your household (continued)

Please provide details of any previous addresses that you have lived at during the last three years (please continue on page 20 if necessary):

Is this address:

If other please state: other

Tied accommodation HM Forces

accommodation Sharing with friends or relatives Owner Occupied Rented from a Housing Association Council rented Privately rented Address: Postcode: Date moved in:

Landlord name:

Landlord contact details

Current Address

If you rent your home please give us details of your landlord:

or address:

Address:

Postcode: Date moved in: Date moved out: Landlord name:

Landlord contact details:

Previous Address 1 Previous Address 2

Reason for leaving:

If yes, do you know your previous membership number:

Yes No

If yes, do you know your previous membership number?

5. Joint Applicant’s current address

Please provide details of any previous addresses that you have lived at during the last three years (please continue on page 20 if necessary):

Is this address:

If other please state: other

Tied accommodation HM Forces

accommodation Sharing with friends or relatives Owner Occupied Rented from a Housing Association Council rented Privately rented Address: Postcode: Date moved in:

Landlord name:

Landlord contact details

Current Address

If you rent your home please give us details of your landlord:

or address:

Address:

Postcode: Date moved in: Date moved out: Landlord name:

Landlord contact details:

Previous Address 1 Previous Address 2

Reason for leaving:

Yes No

6. Employment status

7. Household income

Your employment status and financial information

Employed full time: Self employed:

Part time (under 30 hours): Unemployed:

Retired:

Lead Applicant Joint Applicant

Yes No

Are you or any joint applicant currently a member of the Armed Forces or preparing to leave?

Total income from paid work (Gross/After Tax): Income from other benefits (excluding HB): Total weekly income:

Lead Applicant £ £ £ £ £ £ Joint Applicant Yes No

Do you receive Housing Benefit?

Please provide information about your WEEKLY income (excluding Housing Benefit):

Full HB Part HB

If Yes does HB cover all or part of your rent? £ How much HB do you receive per week?

Reasons for applying for housing

8. About your savings and property

9. Why do you want to be considered for

housing now or in the future?

Yes No

Do you and/or your partner have savings and/or investments?

Yes No

If you do not currently own a property, have you previously owned a property?

£ If Yes what is their current value?

Yes No

Do you own a property?

To be independent/set up own home

Please select your main reason from the list below:

To move to more suitable home For more affordable home To be nearer to family/friends To give or receive support Current home is too large/small Leaving hospital

Other, please state:

End of Assured Shorthold Tenancy Eviction or repossession order Homeless

Asked to leave by family/friends Loss of tied accommodation Issue with property e.g damp Leaving prison

£ If Yes what is the approximate value?

Yes No

Do you have a mortgage?

£ If Yes how much is there left to repay?

10. What is your local connection to the Vale?

Connection to the Vale of Glamorgan

I normally live in the Vale of Glamorgan I am employed in the Vale of Glamorgan My family live in the Vale of Glamorgan Other connection/s to the Vale

I have no connection to the Vale of Glamorgan

Lead Applicant Joint Applicant Please tick only one box below as we can only consider one reason for a local connection.

If you have family members living in the Vale of Glamorgan please provide their name, address and relationship to you:

If you have ticked ‘other connection/s’, or are currently living outside of the Vale of Glamorgan please explain below:

If you are leaving the Armed Forces, Higher Education or Prison, please give a date when you first enlisted or entered:

Title: Forename: Surname: Address: Postcode: Mr / Mrs / Miss / Ms / Other

11. Tell us about your current home?

12.Your future home

Where you live and your future preferences

Is your home a: House

Flat Bungalow

Other (please state)

Mobile home Self-contained bedsit/studio

Sheltered accommodation Caravan or boat

Yes No

Does it have a lift?

If this is a flat what floor is it on?

How many bedrooms does your home have?

Bath Shower

Do you have a bath or shower at your property?

Yes No

Do you have access to a second living room?

Upstairs Downstairs

Is your toilet/bathroom upstairs or downstairs?

Yes No

Do you need an extra bedroom due to illness or disability?

Yes No

Has the property been adapted for your needs or are there existing adaptations?

3rd Floor or above 2nd Floor 1st Floor Ground Lower Ground

What type of property are you interested in? What tenures are you interested in?

Both Home Ownership Rented Homes General Needs Accessible/Adapted Sheltered/Older Persons

Do you share any of the following: Kitchen Bathroom Toilet

13. Your preferred area

A4232

Rail link to Cardiff & London Rail link to

Bridgend & West Wales

Bridgend Cardiff Cardiff Cardiff Cardiff MOD St Athan Cardiff International Airport Barry Island Aberthaw Power Station Ogmore -by-sea

© Crown copyright. All rights reserved. The Vale of Glamorgan Council Licence No. 100023424 Rail link to

Bridgend

Barry

Ward boundaries are approximate only. Not to scale

Vale of Glamorgan Ward Boundaries

We would like to know where in the Vale of Glamorgan you would like to live. This is likely to be the areas you have a local connection to, for example; where you work, children’s schools or where you have family.

Your choices in this section do not affect where you are able to bid on properties. You are able to bid on properties in any area. This information is used to help us plan where new properties are needed.

Referring to the map above, please name your first choice area below:

If you have chosen Barry or Penarth, please refer to the maps opposite to select your preferred ward area and tick the name of the ward as appropriate.

Barry Ward Boundaries

Penarth Ward Boundaries

Buttrills Castleland Dyfan Illtyd Baruc Cadoc Court Gibbonsdown Cornerswell St Augustine’s Stanwell Plymouth Llandough

This information is important for planning where future homes are needed. Not selecting a preferred area will delay your application.

Penarth Road Cornerswell Road Wordsworth Avenue Beach Road Esplanade Windsor Road Penlan Road Dochdwy Road Arcot Street Clive Place Windsor Road Victoria Road Archer Road Stanwell Road Redlands Road Lavernock Road Castle Avenue Westbourne Road Plymouth Road St Peter’s Road Sully Road LLANDOUGH CORNERSWELL ST AUGUSTINE STANWELL PLYMOUTH

14. Do you have any medical issues?

Medical, Mobility and Disability Information

Yes No

Do you require adapted, accessible or level access accommodation, e.g. a property without stairs or suitable for wheelchair access?

If you tick ‘yes’ we will ensure that your details are registered along with the adaptations you need. You will also be referred to the Councils Accessible Homes Register which ensures that people with mobility issues or disabilities are given the best opportunity to access suitable housing.

The Council and its partners currently have a limited number of adapted properties. Priority will be given to the person whose needs can best be met by the property available. A further assessment may be made prior to an offer of accommodation.

Yes No

Does anyone in your household suffer from a diagnosed medical condition or disability that will be improved by moving to alternative accommodation?

If Yes please give details below:

Continue on page 20 if necessary.

Name: Diagnosed medical condition/disability: Details of any medication being taken:

Applicant Joint Applicant

Doctor’s Name: Practice Address:

15. Do you have mobility or support issues?

Yes No

Does anyone in your household need support to be able to live independently or develop independent living skills?

Yes No

Do you have difficulty walking?

If yes do you use any of the following:

Yes No

Do you have difficulty accessing your property?

Yes No

Do you have any equipment to help you with steps or stairs in your current home?

Name: Telephone:

Occupation: Organisation:

Support. If you receive regular help or support from someone like a district nurse, occupational

therapist, home help or support worker then please give this person’s details below:

Wheelchair Walking frame Walking stick

If you use a wheelchair do you use it:

Both Outdoors Indoors

If ‘Yes’ give details:

Please briefly explain how your current home affects your medical condition (continue on page 20 if necessary)

Preventing Homelessness

Yes No

Do you consider yourself to be homeless or threatened with homelessness?

You may be invited to attend an interview to ensure you are given the best possible advice regarding your current housing circumstances.

If you ticked ‘yes’ to any of the above questions, you may be contacted by the Council’s Housing Advice and Homeless service to find out further information.

The Homes4U Partnership is committed to preventing homelessness in the Vale of Glamorgan. We would be grateful if you could answer the following questions honestly so that we can ensure that correct action is taken where necessary.

Yes No

Have you received a Notice to Quit from your landlord?

Yes No

Are you being harassed by your landlord or anyone else?

Yes No

Are you being harassed at your current home?

Yes No

Do you have mortgage or rent arrears against which legal action has commenced? Have you recently left any of the following:

If ‘Yes’ please provide details (continue on page 20 if necessary):

Hospital Care home Prison Armed forces

Information and Declarations

www.homeswapper.co.uk

Yes No

Do you have any current, unspent or pending criminal convictions (except motoring offences are you subject to an anti social behaviour order; or civil injunction for anti social behaviour?

If ‘Yes’, please give details (Continue on page 20 if necessary):

HOMES4U has joined the national mutual exchange scheme ‘Homeswapper’. If you wish to mutual exchange into another property and require information, please contact the

HOMES4U Hotline on 01446 709840 or visit:

To ensure you receive the correct priority banding, please read through your application to check that the information you have given is correct.

Homeswapper

Evidence Supplied

Convictions

Please attach any of the following if applicable and tick to confirm the information has been supplied:

Access rights to children Pregnancy certificate

Notice of eviction Medical / disability evidence

Information and Declarations (continued)

Yes No

Have you or any other applicant been convicted under the Sex Offenders Act 1997 or been placed on the Sex Offenders Register?

If ‘Yes’, please give details (Continue on page 20 if necessary):

Yes No

Are you related to a Vale of Glamorgan Councillor, member of staff or board or committee member of one of our Homes4U partners?

Information

Declaration

If you have indicated on this form an interest in Home Ownership, your data will be entered into the Aspire2Own database.

I am aware that this will involve the disclosure of personal confidential information, which is held on computer or manual files.

I/We authorise the Police, National Probation Service, Social Services Department, doctor or other health professional, or any other Registered Social Landlord to disclose all or any of my personal details whether held on computer under the requirements of the Data Protection Act 1988, the Freedom of Information Act 2000 or contained in manual records held by the relevant organisation in reference to my application for housing.

Any data supplied by you on this form will be processed in accordance with Data Protection Act requirements and in supplying it you consent to the Council processing the data for the purposes that you provide it. All personal information will be treated in the strictest of confidence and will only be used by the Homes4U partners or disclosed to others for a purpose permitted by law.

If you have answered ‘yes’ to any of the questions in the Preventing Homelessness section information may be shared with the Council’s Environmental Health Department.

We may use the information you give us on this form for the detection and prevention of fraud and, if necessary co-operating in anti-fraud measures. Information may be given to other organisations in line with the Data Protection and Freedom of Information Acts.

The Council can contact other persons or organisations to obtain verification of any of the details that you have provided or obtain further information relevant to your application.

A court may grant a possession order on the grounds that the landlord was induced to grant a tenancy by making a false statement made knowingly or recklessly by the tenant.

Anyone who knowingly signs a false declaration or knowingly withholds information may be guilty of an offence and might be prosecuted if the Homes4U partners gain evidence of an intention to obtain a ten-ancy by deception.

It is the responsibility of the applicant to inform Homes4U immediately of any change to the information on this form. The information that you provide will be checked and verified.

Before signing this form below you are reminded of the implications of making a false declaration.

PLEASE NOTE: WHEN A JOINT TENANCY IS REQUESTED BOTH APPLICANTS MUST SIGN THE FORM

Signature Applicant 1 Date Signature Applicant 2 Date

Additional Information

Ethnic Group

GenderandGenderIdentity

Equal Opportunities Monitoring Form

The Vale of Glamorgan Council is committed to achieving equality of opportunity. Please complete this form to help us to achieve this aim.

Male Female

What is your gender?

What is your date of birth? / / At birth were you described as:

Intersex Prefer not to say Male

Female

Scottish Northern Irish English

Welsh British

Other (please specify) Prefer not to say

Disability

Age

Are your day-to-day activities limited due to a physical or mental health condition, illness or disability which has lasted, or is expected to last 12 months or more?

National Identity

Welsh/English/Scottish/Northern Irish/British Irish Gypsy or Irish Traveller Other white background (please specify)

How would you describe your ethnic group?

No Prefer not to say Yes - limited a little

Yes - limited a lot

White

White and Black Caribbean White and Black African White and Asian Other mixed/multiple ethnic background (please specify)

Mixed/multiple ethnic groups

Indian Pakistani Bangladeshi Chinese

Other Asian background (please specify)

Asian/Asian British

African Caribbean

Other Black/African/Caribbean background (please specify)

Black/African/Caribbean/Black British

Arab Other ethnic group (please specify)

No religion Christian (all denominations) Buddhist

Hindu Jewish Muslim Sikh

Any other religion (please specify)

Equal Opportunities Monitoring Form (continued)

Single Married

Separated Divorced Widowed

Prefer not to say Civil Partnership

Separated Dissolved Surviving Partner

What is your legal marital or same sex civil partnership status?

Heterosexual/straight Gay or Lesbian Bisexual

Other Prefer not to say

Prefer not to say

Sexual Identity

Religion

Marriage and Civil Partnership

that is never married and never registered in a same sex civil partnership

in a registered same-sex civil partnership and living with your partner but still legally in a same-sex civil partnership

formerly in a same-sex civil partnership which is now legally dissolved from a same-sex civil partnership

and living with husband/wife

Your personal information will not be disclosed or shared with any other organisation. The information you provide on this form will be used by the Council to monitor access to housing services and to help us develop our policies and practices so that they include all sections of the community.

/ /

Date: Signature: