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General
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Has anyone who will be living in the house had any action taken against them for anti-social behaviour in the last 3 years
Yes
No
Please provide further detail
Has anyone who will be living in the house been convicted of a criminal offence in relation to their house, or in the locality of their house, in the last 3 years
Yes
No
Please provide further detail
Do you or the joint applicant own outright, or have a mortgage on, your current home or any other property
Yes
No
Please provide further detail
Does anyone who will be living in the house have any criminal convictions which are not yet spent under the Rehabilitation of Offenders Act 1974
Yes
No
Please provide further detail
Does anyone who will be living in the house require to register with the police under the Sexual Offences Act 2003
Yes
No
Please provide further detail
Do you receive any particular support from any agencies to help you manage in your current home?
Yes
No
Please provide details below
Are you a young person (between the age of 16 - 25 years) leaving residential care provided by a local authority, and as part of an agreed Pathways Assessment Process?
Yes
No
Please provide details of your allocated Social Worker below
Have you ever lived in a property owned or managed by the association?
Yes
No
Please provide details below
Are you experiencing harassment or domestic abuse in your present accommodation?
Yes
No
Please provide details below
If you are suffering harassment or domestic abuse at your current address, please provide full details in the box above. We can provide advice and information on specialist agencies dealing with this and we also advise you to seek urgent assistance from the local authority’s Community Casework Team.
Are you or anyone moving with you an asylum seeker or subject to immigration controls?
Yes
No
Please provide details below
Are you, your partner or joint applicant staying in the UK on a spouse visa?
Yes
No
Please provide details below
Are you, your partner or joint applicant staying in the UK on another type of visa?
Yes
No
Please provide details below
Have you ever been evicted from a property?
Yes
No
Please provide details below
Have you or anyone moving with you been convicted of or have any pending charges in relation to the misuse of drugs?
Yes
No
Please provide details below including when and where the convictions or alleged offences took place
Are you, or anyone who would be moving with you, related to a Committee or Area Association member or employee of the Association? The assessment of your application will not be affected If you answer yes to this question.
Yes
No
Please provide details below
Is anyone included in this form pregnant
Yes
No
Name of person who is pregnant
Pregnancy due date
Day
Month
Year
In order for us to include the baby in your household composition assessment, we require written proof of pregnancy. This should be submitted to this office three months prior to the expected due date. For example, a baby due on 1 June would be included in the household from 1 March.
Do you or the joint applicant provide kinship care
Yes
No
Please provide details of your kinship care arrangement below
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