Applicant Visit

• Property address, Description and Bedroom number (please insert code number from list below)

• Type of property
  1. House. 2. Bungalow. 3. Maisonette. 4. Ground floor flat. 5. Flat above ground floor. 6. Studio flat

• Source of Referral

  Internal Transfer

  Direct Application

  Other

  Nomination / CBL

• If Source of Referral is Other Please State Here

• Gender

  Male

  Female

• Title

  Miss

  Mr

  Mrs

  Ms

• First Name(s)

• Last Name

• Date of Birth

  Date

• Nationality

  Select 1. UK National Resident 2. UK National returning from Overseas 3. Czech Republic 4. Estonia 5. Hungary 6. Latvia 7. Lithuania 8. Poland 9. Slovakia 10. Slovenia 11. Other European Economic Area Country 12. Any Other Country 13. Prefer Not To Answer 14. Bulgaria 15. Romania

  • 1. UK National Resident
  • 2. UK National returning from Overseas
  • 3. Czech Republic
  • 4. Estonia
  • 5. Hungary
  • 6. Latvia
  • 7. Lithuania
  • 8. Poland
  • 9. Slovakia
  • 10. Slovenia
  • 11. Other European Economic Area Country
  • 12. Any Other Country
  • 13. Prefer Not To Answer
  • 14. Bulgaria
  • 15. Romania

• EEA Countries are: Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Liechtenstein, Luxembourg, Malta, Netherlands, Norway, Portugal, Spain, Sweden and Switzerland.

• Ethnicity

  Select 1. White English, Scottish, Welsh, Northern Ireland, British 2. White Irish 3. Gypsy or Irish Traveller 4. White Other 5. Mixed White and Black Caribbean 6. Mixed White and Black African 7. Mixed White and Black Asian 8. Mixed White and Black Other 9. Asian or Asian British Indian 10. Asian or Asian British Pakistan 11. Asian or Asian British Bangladeshi 12. Asian or Asian British Chinese 13. Asian or Asian British Other 14. Black African, Caribbean or Black British Caribbean 15. Black African, Caribbean or Black British African 16. Black African, Caribbean or Black British Other 17. Other Ethnic Group Arab 18. Other Ethnic Group Other 19. Prefer Not to Answer

  • 1. White English, Scottish, Welsh, Northern Ireland, British
  • 2. White Irish
  • 3. Gypsy or Irish Traveller
  • 4. White Other
  • 5. Mixed White and Black Caribbean
  • 6. Mixed White and Black African
  • 7. Mixed White and Black Asian
  • 8. Mixed White and Black Other
  • 9. Asian or Asian British Indian
  • 10. Asian or Asian British Pakistan
  • 11. Asian or Asian British Bangladeshi
  • 12. Asian or Asian British Chinese
  • 13. Asian or Asian British Other
  • 14. Black African, Caribbean or Black British Caribbean
  • 15. Black African, Caribbean or Black British African
  • 16. Black African, Caribbean or Black British Other
  • 17. Other Ethnic Group Arab
  • 18. Other Ethnic Group Other
  • 19. Prefer Not to Answer

• Religion

  Select 1. Christian 2. Hindu 3. Muslim 4. Sikh 5. Jewish 6. Buddhist 7. No Religion 8. Other 9. Prefer Not to Answer

  • 1. Christian
  • 2. Hindu
  • 3. Muslim
  • 4. Sikh
  • 5. Jewish
  • 6. Buddhist
  • 7. No Religion
  • 8. Other
  • 9. Prefer Not to Answer

• Sexuality

  1. Heterosexual

  2. Gay

  3. Lesbian

  4. Bisexual

  5. Prefer Not to Answer

• Disability

  Select 1. Not Disabled 2. Hearing Disability 3. Mental Health Issues 4. Speech Impediment 5. Learning Disability 6. Mobility Disability 7. Visual Disability 8. Other Disability 9. Prefer Not to Answer

  • 1. Not Disabled
  • 2. Hearing Disability
  • 3. Mental Health Issues
  • 4. Speech Impediment
  • 5. Learning Disability
  • 6. Mobility Disability
  • 7. Visual Disability
  • 8. Other Disability
  • 9. Prefer Not to Answer

• Economic Status

  Select 1. Full Time Work (30 hrs or more per week) 2. Part Time Work (less than 30hrs per week) 3. Government Training / New Deal 4. Job Seeker 5. Retired 6. Not Seeking Work 7. Full Time Student 8. Long Term Sick / Disabled 9. Child under 16 0. Other Adult

  • 1. Full Time Work (30 hrs or more per week)
  • 2. Part Time Work (less than 30hrs per week)
  • 3. Government Training / New Deal
  • 4. Job Seeker
  • 5. Retired
  • 6. Not Seeking Work
  • 7. Full Time Student
  • 8. Long Term Sick / Disabled
  • 9. Child under 16
  • 0. Other Adult

• Full Current Address

• Postcode

• Applicant Reference Number

• Date of Visit

  Date

• N.O Carrying Out Visit

• Contact Telephone Number(s)

• E-Mail Address

• Is Anyone in the Household Pregnant - if so who and due date........

Joint Applicant

• Gender

  Male

  Female

• Title

  Miss

  Mr

  Mrs

  Ms

• First Name(s)

• Last Name

• Date of Birth

  Date

• Nationality

  Select 1. UK National Resident 2. UK National returning from Overseas 3. Czech Republic 4. Estonia 5. Hungary 6. Latvia 7. Lithuania 8. Poland 9. Slovakia 10. Slovenia 11. Other European Economic Area Country 12. Any Other Country 13. Prefer Not To Answer 14. Bulgaria 15. Romania

  • 1. UK National Resident
  • 2. UK National returning from Overseas
  • 3. Czech Republic
  • 4. Estonia
  • 5. Hungary
  • 6. Latvia
  • 7. Lithuania
  • 8. Poland
  • 9. Slovakia
  • 10. Slovenia
  • 11. Other European Economic Area Country
  • 12. Any Other Country
  • 13. Prefer Not To Answer
  • 14. Bulgaria
  • 15. Romania

• Ethnicity

  Select 1. White English, Scottish, Welsh, Northern Ireland, British 2. White Irish 3. Gypsy or Irish Traveller 4. White Other 5. Mixed White and Black Caribbean 6. Mixed White and Black African 7. Mixed White and Black Asian 8. Mixed White and Black Other 9. Asian or Asian British Indian 10. Asian or Asian British Pakistan 11. Asian or Asian British Bangladeshi 12. Asian or Asian British Chinese 13. Asian or Asian British Other 14. Black African, Caribbean or Black British Caribbean 15. Black African, Caribbean or Black British African 16. Black African, Caribbean or Black British Other 17. Other Ethnic Group Arab 18. Other Ethnic Group Other 19. Prefer Not to Answer

  • 1. White English, Scottish, Welsh, Northern Ireland, British
  • 2. White Irish
  • 3. Gypsy or Irish Traveller
  • 4. White Other
  • 5. Mixed White and Black Caribbean
  • 6. Mixed White and Black African
  • 7. Mixed White and Black Asian
  • 8. Mixed White and Black Other
  • 9. Asian or Asian British Indian
  • 10. Asian or Asian British Pakistan
  • 11. Asian or Asian British Bangladeshi
  • 12. Asian or Asian British Chinese
  • 13. Asian or Asian British Other
  • 14. Black African, Caribbean or Black British Caribbean
  • 15. Black African, Caribbean or Black British African
  • 16. Black African, Caribbean or Black British Other
  • 17. Other Ethnic Group Arab
  • 18. Other Ethnic Group Other
  • 19. Prefer Not to Answer

• Religion

  Select 1. Christian 2. Hindu 3. Muslim 4. Sikh 5. Jewish 6. Buddhist 7. No Religion 8. Other 9. Prefer Not to Answer

  • 1. Christian
  • 2. Hindu
  • 3. Muslim
  • 4. Sikh
  • 5. Jewish
  • 6. Buddhist
  • 7. No Religion
  • 8. Other
  • 9. Prefer Not to Answer

• Sexuality

  1. Heterosexual

  2. Gay

  3. Lesbian

  4. Bisexual

  5. Prefer Not to Answer

• Disability

  Select 1. Not Disabled 2. Hearing Disability 3. Mental Health Issues 4. Speech Impediment 5. Learning Disability 6. Mobility Disability 7. Visual Disability 8. Other Disability 9. Prefer Not to Answer

  • 1. Not Disabled
  • 2. Hearing Disability
  • 3. Mental Health Issues
  • 4. Speech Impediment
  • 5. Learning Disability
  • 6. Mobility Disability
  • 7. Visual Disability
  • 8. Other Disability
  • 9. Prefer Not to Answer

• Economic Status

  Select 1. Full Time Work (30 hrs or more per week) 2. Part Time Work (less than 30hrs per week) 3. Government Training / New Deal 4. Job Seeker 5. Retired 6. Not Seeking Work 7. Full Time Student 8. Long Term Sick / Disabled 9. Child under 16 0. Other Adult

  • 1. Full Time Work (30 hrs or more per week)
  • 2. Part Time Work (less than 30hrs per week)
  • 3. Government Training / New Deal
  • 4. Job Seeker
  • 5. Retired
  • 6. Not Seeking Work
  • 7. Full Time Student
  • 8. Long Term Sick / Disabled
  • 9. Child under 16
  • 0. Other Adult

• How Are They Related To You?

  Select Brother Daughter Father Mother Sister Son Partner Applicant Extended Family Not Related

  • Brother
  • Daughter
  • Father
  • Mother
  • Sister
  • Son
  • Partner Applicant
  • Extended Family
  • Not Related

1st Additional Household Member

• Gender

  Male

  Female

• Title

  Miss

  Mr

  Mrs

  Ms

• First Name(s)

• Last Name

• Date of Birth

  Date

• Nationality

  Select 1. UK National Resident 2. UK National returning from Overseas 3. Czech Republic 4. Estonia 5. Hungary 6. Latvia 7. Lithuania 8. Poland 9. Slovakia 10. Slovenia 11. Other European Economic Area Country 12. Any Other Country 13. Prefer Not To Answer 14. Bulgaria 15. Romania

  • 1. UK National Resident
  • 2. UK National returning from Overseas
  • 3. Czech Republic
  • 4. Estonia
  • 5. Hungary
  • 6. Latvia
  • 7. Lithuania
  • 8. Poland
  • 9. Slovakia
  • 10. Slovenia
  • 11. Other European Economic Area Country
  • 12. Any Other Country
  • 13. Prefer Not To Answer
  • 14. Bulgaria
  • 15. Romania

• Ethnicity

  Select 1. White English, Scottish, Welsh, Northern Ireland, British 2. White Irish 3. Gypsy or Irish Traveller 4. White Other 5. Mixed White and Black Caribbean 6. Mixed White and Black African 7. Mixed White and Black Asian 8. Mixed White and Black Other 9. Asian or Asian British Indian 10. Asian or Asian British Pakistan 11. Asian or Asian British Bangladeshi 12. Asian or Asian British Chinese 13. Asian or Asian British Other 14. Black African, Caribbean or Black British Caribbean 15. Black African, Caribbean or Black British African 16. Black African, Caribbean or Black British Other 17. Other Ethnic Group Arab 18. Other Ethnic Group Other 19. Prefer Not to Answer

  • 1. White English, Scottish, Welsh, Northern Ireland, British
  • 2. White Irish
  • 3. Gypsy or Irish Traveller
  • 4. White Other
  • 5. Mixed White and Black Caribbean
  • 6. Mixed White and Black African
  • 7. Mixed White and Black Asian
  • 8. Mixed White and Black Other
  • 9. Asian or Asian British Indian
  • 10. Asian or Asian British Pakistan
  • 11. Asian or Asian British Bangladeshi
  • 12. Asian or Asian British Chinese
  • 13. Asian or Asian British Other
  • 14. Black African, Caribbean or Black British Caribbean
  • 15. Black African, Caribbean or Black British African
  • 16. Black African, Caribbean or Black British Other
  • 17. Other Ethnic Group Arab
  • 18. Other Ethnic Group Other
  • 19. Prefer Not to Answer

• Religion

  Select 1. Christian 2. Hindu 3. Muslim 4. Sikh 5. Jewish 6. Buddhist 7. No Religion 8. Other 9. Prefer Not to Answer

  • 1. Christian
  • 2. Hindu
  • 3. Muslim
  • 4. Sikh
  • 5. Jewish
  • 6. Buddhist
  • 7. No Religion
  • 8. Other
  • 9. Prefer Not to Answer

• Sexuality

  1. Heterosexual

  2. Gay

  3. Lesbian

  4. Bisexual

  5. Prefer Not to Answer

• Disability

  Select 1. Not Disabled 2. Hearing Disability 3. Mental Health Issues 4. Speech Impediment 5. Learning Disability 6. Mobility Disability 7. Visual Disability 8. Other Disability 9. Prefer Not to Answer

  • 1. Not Disabled
  • 2. Hearing Disability
  • 3. Mental Health Issues
  • 4. Speech Impediment
  • 5. Learning Disability
  • 6. Mobility Disability
  • 7. Visual Disability
  • 8. Other Disability
  • 9. Prefer Not to Answer

• Economic Status

  Select 1. Full Time Work (30 hrs or more per week) 2. Part Time Work (less than 30hrs per week) 3. Government Training / New Deal 4. Job Seeker 5. Retired 6. Not Seeking Work 7. Full Time Student 8. Long Term Sick / Disabled 9. Child under 16 0. Other Adult

  • 1. Full Time Work (30 hrs or more per week)
  • 2. Part Time Work (less than 30hrs per week)
  • 3. Government Training / New Deal
  • 4. Job Seeker
  • 5. Retired
  • 6. Not Seeking Work
  • 7. Full Time Student
  • 8. Long Term Sick / Disabled
  • 9. Child under 16
  • 0. Other Adult

• How Are They Related To You?

  Select Brother Daughter Father Mother Sister Son Partner Applicant Extended Family Not Related

  • Brother
  • Daughter
  • Father
  • Mother
  • Sister
  • Son
  • Partner Applicant
  • Extended Family
  • Not Related

2nd Additional Household Member

• Gender

  Male

  Female

• Title

  Miss

  Mr

  Mrs

  Ms

• First Name(s)

• Last Name

• Date of Birth

  Date

• Nationality

  Select 1. UK National Resident 2. UK National returning from Overseas 3. Czech Republic 4. Estonia 5. Hungary 6. Latvia 7. Lithuania 8. Poland 9. Slovakia 10. Slovenia 11. Other European Economic Area Country 12. Any Other Country 13. Prefer Not To Answer 14. Bulgaria 15. Romania

  • 1. UK National Resident
  • 2. UK National returning from Overseas
  • 3. Czech Republic
  • 4. Estonia
  • 5. Hungary
  • 6. Latvia
  • 7. Lithuania
  • 8. Poland
  • 9. Slovakia
  • 10. Slovenia
  • 11. Other European Economic Area Country
  • 12. Any Other Country
  • 13. Prefer Not To Answer
  • 14. Bulgaria
  • 15. Romania

• Ethnicity

  Select 1. White English, Scottish, Welsh, Northern Ireland, British 2. White Irish 3. Gypsy or Irish Traveller 4. White Other 5. Mixed White and Black Caribbean 6. Mixed White and Black African 7. Mixed White and Black Asian 8. Mixed White and Black Other 9. Asian or Asian British Indian 10. Asian or Asian British Pakistan 11. Asian or Asian British Bangladeshi 12. Asian or Asian British Chinese 13. Asian or Asian British Other 14. Black African, Caribbean or Black British Caribbean 15. Black African, Caribbean or Black British African 16. Black African, Caribbean or Black British Other 17. Other Ethnic Group Arab 18. Other Ethnic Group Other 19. Prefer Not to Answer

  • 1. White English, Scottish, Welsh, Northern Ireland, British
  • 2. White Irish
  • 3. Gypsy or Irish Traveller
  • 4. White Other
  • 5. Mixed White and Black Caribbean
  • 6. Mixed White and Black African
  • 7. Mixed White and Black Asian
  • 8. Mixed White and Black Other
  • 9. Asian or Asian British Indian
  • 10. Asian or Asian British Pakistan
  • 11. Asian or Asian British Bangladeshi
  • 12. Asian or Asian British Chinese
  • 13. Asian or Asian British Other
  • 14. Black African, Caribbean or Black British Caribbean
  • 15. Black African, Caribbean or Black British African
  • 16. Black African, Caribbean or Black British Other
  • 17. Other Ethnic Group Arab
  • 18. Other Ethnic Group Other
  • 19. Prefer Not to Answer

• Religion

  Select 1. Christian 2. Hindu 3. Muslim 4. Sikh 5. Jewish 6. Buddhist 7. No Religion 8. Other 9. Prefer Not to Answer

  • 1. Christian
  • 2. Hindu
  • 3. Muslim
  • 4. Sikh
  • 5. Jewish
  • 6. Buddhist
  • 7. No Religion
  • 8. Other
  • 9. Prefer Not to Answer

• Sexuality

  1. Heterosexual

  2. Gay

  3. Lesbian

  4. Bisexual

  5. Prefer Not to Answer

• Disability

  Select 1. Not Disabled 2. Hearing Disability 3. Mental Health Issues 4. Speech Impediment 5. Learning Disability 6. Mobility Disability 7. Visual Disability 8. Other Disability 9. Prefer Not to Answer

  • 1. Not Disabled
  • 2. Hearing Disability
  • 3. Mental Health Issues
  • 4. Speech Impediment
  • 5. Learning Disability
  • 6. Mobility Disability
  • 7. Visual Disability
  • 8. Other Disability
  • 9. Prefer Not to Answer

• Economic Status

  Select 1. Full Time Work (30 hrs or more per week) 2. Part Time Work (less than 30hrs per week) 3. Government Training / New Deal 4. Job Seeker 5. Retired 6. Not Seeking Work 7. Full Time Student 8. Long Term Sick / Disabled 9. Child under 16 0. Other Adult

  • 1. Full Time Work (30 hrs or more per week)
  • 2. Part Time Work (less than 30hrs per week)
  • 3. Government Training / New Deal
  • 4. Job Seeker
  • 5. Retired
  • 6. Not Seeking Work
  • 7. Full Time Student
  • 8. Long Term Sick / Disabled
  • 9. Child under 16
  • 0. Other Adult

• How Are They Related To You?

  Select Brother Daughter Father Mother Sister Son Partner Applicant Extended Family Not Related

  • Brother
  • Daughter
  • Father
  • Mother
  • Sister
  • Son
  • Partner Applicant
  • Extended Family
  • Not Related

3rd Additional Household Member

• Gender

  Male

  Female

• Title

  Miss

  Mr

  Mrs

  Ms

• First Name(s)

• Last Name

• Date of Birth

  Date

• Nationality

  Select 1. UK National Resident 2. UK National returning from Overseas 3. Czech Republic 4. Estonia 5. Hungary 6. Latvia 7. Lithuania 8. Poland 9. Slovakia 10. Slovenia 11. Other European Economic Area Country 12. Any Other Country 13. Prefer Not To Answer 14. Bulgaria 15. Romania

  • 1. UK National Resident
  • 2. UK National returning from Overseas
  • 3. Czech Republic
  • 4. Estonia
  • 5. Hungary
  • 6. Latvia
  • 7. Lithuania
  • 8. Poland
  • 9. Slovakia
  • 10. Slovenia
  • 11. Other European Economic Area Country
  • 12. Any Other Country
  • 13. Prefer Not To Answer
  • 14. Bulgaria
  • 15. Romania

• Ethnicity

  Select 1. White English, Scottish, Welsh, Northern Ireland, British 2. White Irish 3. Gypsy or Irish Traveller 4. White Other 5. Mixed White and Black Caribbean 6. Mixed White and Black African 7. Mixed White and Black Asian 8. Mixed White and Black Other 9. Asian or Asian British Indian 10. Asian or Asian British Pakistan 11. Asian or Asian British Bangladeshi 12. Asian or Asian British Chinese 13. Asian or Asian British Other 14. Black African, Caribbean or Black British Caribbean 15. Black African, Caribbean or Black British African 16. Black African, Caribbean or Black British Other 17. Other Ethnic Group Arab 18. Other Ethnic Group Other 19. Prefer Not to Answer

  • 1. White English, Scottish, Welsh, Northern Ireland, British
  • 2. White Irish
  • 3. Gypsy or Irish Traveller
  • 4. White Other
  • 5. Mixed White and Black Caribbean
  • 6. Mixed White and Black African
  • 7. Mixed White and Black Asian
  • 8. Mixed White and Black Other
  • 9. Asian or Asian British Indian
  • 10. Asian or Asian British Pakistan
  • 11. Asian or Asian British Bangladeshi
  • 12. Asian or Asian British Chinese
  • 13. Asian or Asian British Other
  • 14. Black African, Caribbean or Black British Caribbean
  • 15. Black African, Caribbean or Black British African
  • 16. Black African, Caribbean or Black British Other
  • 17. Other Ethnic Group Arab
  • 18. Other Ethnic Group Other
  • 19. Prefer Not to Answer

• Religion

  Select 1. Christian 2. Hindu 3. Muslim 4. Sikh 5. Jewish 6. Buddhist 7. No Religion 8. Other 9. Prefer Not to Answer

  • 1. Christian
  • 2. Hindu
  • 3. Muslim
  • 4. Sikh
  • 5. Jewish
  • 6. Buddhist
  • 7. No Religion
  • 8. Other
  • 9. Prefer Not to Answer

• Sexuality

  1. Heterosexual

  2. Gay

  3. Lesbian

  4. Bisexual

  5. Prefer Not to Answer

• Disability

  Select 1. Not Disabled 2. Hearing Disability 3. Mental Health Issues 4. Speech Impediment 5. Learning Disability 6. Mobility Disability 7. Visual Disability 8. Other Disability 9. Prefer Not to Answer

  • 1. Not Disabled
  • 2. Hearing Disability
  • 3. Mental Health Issues
  • 4. Speech Impediment
  • 5. Learning Disability
  • 6. Mobility Disability
  • 7. Visual Disability
  • 8. Other Disability
  • 9. Prefer Not to Answer

• Economic Status

  Select 1. Full Time Work (30 hrs or more per week) 2. Part Time Work (less than 30hrs per week) 3. Government Training / New Deal 4. Job Seeker 5. Retired 6. Not Seeking Work 7. Full Time Student 8. Long Term Sick / Disabled 9. Child under 16 0. Other Adult

  • 1. Full Time Work (30 hrs or more per week)
  • 2. Part Time Work (less than 30hrs per week)
  • 3. Government Training / New Deal
  • 4. Job Seeker
  • 5. Retired
  • 6. Not Seeking Work
  • 7. Full Time Student
  • 8. Long Term Sick / Disabled
  • 9. Child under 16
  • 0. Other Adult

• How Are They Related To You?

  Select Brother Daughter Father Mother Sister Son Partner Applicant Extended Family Not Related

  • Brother
  • Daughter
  • Father
  • Mother
  • Sister
  • Son
  • Partner Applicant
  • Extended Family
  • Not Related

4th Additional Household Member

• Gender

  Male

  Female

• Title

  Miss

  Mr

  Mrs

  Ms

• First Name(s)

• Last Name

• Date of Birth

  Date

• Nationality

  Select 1. UK National Resident 2. UK National returning from Overseas 3. Czech Republic 4. Estonia 5. Hungary 6. Latvia 7. Lithuania 8. Poland 9. Slovakia 10. Slovenia 11. Other European Economic Area Country 12. Any Other Country 13. Prefer Not To Answer 14. Bulgaria 15. Romania

  • 1. UK National Resident
  • 2. UK National returning from Overseas
  • 3. Czech Republic
  • 4. Estonia
  • 5. Hungary
  • 6. Latvia
  • 7. Lithuania
  • 8. Poland
  • 9. Slovakia
  • 10. Slovenia
  • 11. Other European Economic Area Country
  • 12. Any Other Country
  • 13. Prefer Not To Answer
  • 14. Bulgaria
  • 15. Romania

• Ethnicity

  Select 1. White English, Scottish, Welsh, Northern Ireland, British 2. White Irish 3. Gypsy or Irish Traveller 4. White Other 5. Mixed White and Black Caribbean 6. Mixed White and Black African 7. Mixed White and Black Asian 8. Mixed White and Black Other 9. Asian or Asian British Indian 10. Asian or Asian British Pakistan 11. Asian or Asian British Bangladeshi 12. Asian or Asian British Chinese 13. Asian or Asian British Other 14. Black African, Caribbean or Black British Caribbean 15. Black African, Caribbean or Black British African 16. Black African, Caribbean or Black British Other 17. Other Ethnic Group Arab 18. Other Ethnic Group Other 19. Prefer Not to Answer

  • 1. White English, Scottish, Welsh, Northern Ireland, British
  • 2. White Irish
  • 3. Gypsy or Irish Traveller
  • 4. White Other
  • 5. Mixed White and Black Caribbean
  • 6. Mixed White and Black African
  • 7. Mixed White and Black Asian
  • 8. Mixed White and Black Other
  • 9. Asian or Asian British Indian
  • 10. Asian or Asian British Pakistan
  • 11. Asian or Asian British Bangladeshi
  • 12. Asian or Asian British Chinese
  • 13. Asian or Asian British Other
  • 14. Black African, Caribbean or Black British Caribbean
  • 15. Black African, Caribbean or Black British African
  • 16. Black African, Caribbean or Black British Other
  • 17. Other Ethnic Group Arab
  • 18. Other Ethnic Group Other
  • 19. Prefer Not to Answer

• Religion

  Select 1. Christian 2. Hindu 3. Muslim 4. Sikh 5. Jewish 6. Buddhist 7. No Religion 8. Other 9. Prefer Not to Answer

  • 1. Christian
  • 2. Hindu
  • 3. Muslim
  • 4. Sikh
  • 5. Jewish
  • 6. Buddhist
  • 7. No Religion
  • 8. Other
  • 9. Prefer Not to Answer

• Sexuality

  1. Heterosexual

  2. Gay

  3. Lesbian

  4. Bisexual

  5. Prefer Not to Answer

• Disability

  Select 1. Not Disabled 2. Hearing Disability 3. Mental Health Issues 4. Speech Impediment 5. Learning Disability 6. Mobility Disability 7. Visual Disability 8. Other Disability 9. Prefer Not to Answer

  • 1. Not Disabled
  • 2. Hearing Disability
  • 3. Mental Health Issues
  • 4. Speech Impediment
  • 5. Learning Disability
  • 6. Mobility Disability
  • 7. Visual Disability
  • 8. Other Disability
  • 9. Prefer Not to Answer

• Economic Status

  Select 1. Full Time Work (30 hrs or more per week) 2. Part Time Work (less than 30hrs per week) 3. Government Training / New Deal 4. Job Seeker 5. Retired 6. Not Seeking Work 7. Full Time Student 8. Long Term Sick / Disabled 9. Child under 16 0. Other Adult

  • 1. Full Time Work (30 hrs or more per week)
  • 2. Part Time Work (less than 30hrs per week)
  • 3. Government Training / New Deal
  • 4. Job Seeker
  • 5. Retired
  • 6. Not Seeking Work
  • 7. Full Time Student
  • 8. Long Term Sick / Disabled
  • 9. Child under 16
  • 0. Other Adult

• How Are They Related To You?

  Select Brother Daughter Father Mother Sister Son Partner Applicant Extended Family Not Related

  • Brother
  • Daughter
  • Father
  • Mother
  • Sister
  • Son
  • Partner Applicant
  • Extended Family
  • Not Related

5th Additional Household Member

• Gender

  Male

  Female

• Title

  Miss

  Mr

  Mrs

  Ms

• First Name(s)

• Last Name

• Date of Birth

  Date

• Nationality

  Select 1. UK National Resident 2. UK National returning from Overseas 3. Czech Republic 4. Estonia 5. Hungary 6. Latvia 7. Lithuania 8. Poland 9. Slovakia 10. Slovenia 11. Other European Economic Area Country 12. Any Other Country 13. Prefer Not To Answer 14. Bulgaria 15. Romania

  • 1. UK National Resident
  • 2. UK National returning from Overseas
  • 3. Czech Republic
  • 4. Estonia
  • 5. Hungary
  • 6. Latvia
  • 7. Lithuania
  • 8. Poland
  • 9. Slovakia
  • 10. Slovenia
  • 11. Other European Economic Area Country
  • 12. Any Other Country
  • 13. Prefer Not To Answer
  • 14. Bulgaria
  • 15. Romania

• Ethnicity

  Select 1. White English, Scottish, Welsh, Northern Ireland, British 2. White Irish 3. Gypsy or Irish Traveller 4. White Other 5. Mixed White and Black Caribbean 6. Mixed White and Black African 7. Mixed White and Black Asian 8. Mixed White and Black Other 9. Asian or Asian British Indian 10. Asian or Asian British Pakistan 11. Asian or Asian British Bangladeshi 12. Asian or Asian British Chinese 13. Asian or Asian British Other 14. Black African, Caribbean or Black British Caribbean 15. Black African, Caribbean or Black British African 16. Black African, Caribbean or Black British Other 17. Other Ethnic Group Arab 18. Other Ethnic Group Other 19. Prefer Not to Answer

  • 1. White English, Scottish, Welsh, Northern Ireland, British
  • 2. White Irish
  • 3. Gypsy or Irish Traveller
  • 4. White Other
  • 5. Mixed White and Black Caribbean
  • 6. Mixed White and Black African
  • 7. Mixed White and Black Asian
  • 8. Mixed White and Black Other
  • 9. Asian or Asian British Indian
  • 10. Asian or Asian British Pakistan
  • 11. Asian or Asian British Bangladeshi
  • 12. Asian or Asian British Chinese
  • 13. Asian or Asian British Other
  • 14. Black African, Caribbean or Black British Caribbean
  • 15. Black African, Caribbean or Black British African
  • 16. Black African, Caribbean or Black British Other
  • 17. Other Ethnic Group Arab
  • 18. Other Ethnic Group Other
  • 19. Prefer Not to Answer

• Religion

  Select 1. Christian 2. Hindu 3. Muslim 4. Sikh 5. Jewish 6. Buddhist 7. No Religion 8. Other 9. Prefer Not to Answer

  • 1. Christian
  • 2. Hindu
  • 3. Muslim
  • 4. Sikh
  • 5. Jewish
  • 6. Buddhist
  • 7. No Religion
  • 8. Other
  • 9. Prefer Not to Answer

• Sexuality

  1. Heterosexual

  2. Gay

  3. Lesbian

  4. Bisexual

  5. Prefer Not to Answer

• Disability

  Select 1. Not Disabled 2. Hearing Disability 3. Mental Health Issues 4. Speech Impediment 5. Learning Disability 6. Mobility Disability 7. Visual Disability 8. Other Disability 9. Prefer Not to Answer

  • 1. Not Disabled
  • 2. Hearing Disability
  • 3. Mental Health Issues
  • 4. Speech Impediment
  • 5. Learning Disability
  • 6. Mobility Disability
  • 7. Visual Disability
  • 8. Other Disability
  • 9. Prefer Not to Answer

• Economic Status

  Select 1. Full Time Work (30 hrs or more per week) 2. Part Time Work (less than 30hrs per week) 3. Government Training / New Deal 4. Job Seeker 5. Retired 6. Not Seeking Work 7. Full Time Student 8. Long Term Sick / Disabled 9. Child under 16 0. Other Adult

  • 1. Full Time Work (30 hrs or more per week)
  • 2. Part Time Work (less than 30hrs per week)
  • 3. Government Training / New Deal
  • 4. Job Seeker
  • 5. Retired
  • 6. Not Seeking Work
  • 7. Full Time Student
  • 8. Long Term Sick / Disabled
  • 9. Child under 16
  • 0. Other Adult

• How Are They Related To You?

  Select Brother Daughter Father Mother Sister Son Partner Applicant Extended Family Not Related

  • Brother
  • Daughter
  • Father
  • Mother
  • Sister
  • Son
  • Partner Applicant
  • Extended Family
  • Not Related

6th Additional Household Member

• Gender

  Male

  Female

• Title

  Miss

  Mr

  Mrs

  Ms

• First Name(s)

• Last Name

• Date of Birth

  Date

• Nationality

  Select 1. UK National Resident 2. UK National returning from Overseas 3. Czech Republic 4. Estonia 5. Hungary 6. Latvia 7. Lithuania 8. Poland 9. Slovakia 10. Slovenia 11. Other European Economic Area Country 12. Any Other Country 13. Prefer Not To Answer 14. Bulgaria 15. Romania

  • 1. UK National Resident
  • 2. UK National returning from Overseas
  • 3. Czech Republic
  • 4. Estonia
  • 5. Hungary
  • 6. Latvia
  • 7. Lithuania
  • 8. Poland
  • 9. Slovakia
  • 10. Slovenia
  • 11. Other European Economic Area Country
  • 12. Any Other Country
  • 13. Prefer Not To Answer
  • 14. Bulgaria
  • 15. Romania

• Ethnicity

  Select 1. White English, Scottish, Welsh, Northern Ireland, British 2. White Irish 3. Gypsy or Irish Traveller 4. White Other 5. Mixed White and Black Caribbean 6. Mixed White and Black African 7. Mixed White and Black Asian 8. Mixed White and Black Other 9. Asian or Asian British Indian 10. Asian or Asian British Pakistan 11. Asian or Asian British Bangladeshi 12. Asian or Asian British Chinese 13. Asian or Asian British Other 14. Black African, Caribbean or Black British Caribbean 15. Black African, Caribbean or Black British African 16. Black African, Caribbean or Black British Other 17. Other Ethnic Group Arab 18. Other Ethnic Group Other 19. Prefer Not to Answer

  • 1. White English, Scottish, Welsh, Northern Ireland, British
  • 2. White Irish
  • 3. Gypsy or Irish Traveller
  • 4. White Other
  • 5. Mixed White and Black Caribbean
  • 6. Mixed White and Black African
  • 7. Mixed White and Black Asian
  • 8. Mixed White and Black Other
  • 9. Asian or Asian British Indian
  • 10. Asian or Asian British Pakistan
  • 11. Asian or Asian British Bangladeshi
  • 12. Asian or Asian British Chinese
  • 13. Asian or Asian British Other
  • 14. Black African, Caribbean or Black British Caribbean
  • 15. Black African, Caribbean or Black British African
  • 16. Black African, Caribbean or Black British Other
  • 17. Other Ethnic Group Arab
  • 18. Other Ethnic Group Other
  • 19. Prefer Not to Answer

• Religion

  Select 1. Christian 2. Hindu 3. Muslim 4. Sikh 5. Jewish 6. Buddhist 7. No Religion 8. Other 9. Prefer Not to Answer

  • 1. Christian
  • 2. Hindu
  • 3. Muslim
  • 4. Sikh
  • 5. Jewish
  • 6. Buddhist
  • 7. No Religion
  • 8. Other
  • 9. Prefer Not to Answer

• Sexuality

  1. Heterosexual

  2. Gay

  3. Lesbian

  4. Bisexual

  5. Prefer Not to Answer

• Disability

  Select 1. Not Disabled 2. Hearing Disability 3. Mental Health Issues 4. Speech Impediment 5. Learning Disability 6. Mobility Disability 7. Visual Disability 8. Other Disability 9. Prefer Not to Answer

  • 1. Not Disabled
  • 2. Hearing Disability
  • 3. Mental Health Issues
  • 4. Speech Impediment
  • 5. Learning Disability
  • 6. Mobility Disability
  • 7. Visual Disability
  • 8. Other Disability
  • 9. Prefer Not to Answer

• Economic Status

  Select 1. Full Time Work (30 hrs or more per week) 2. Part Time Work (less than 30hrs per week) 3. Government Training / New Deal 4. Job Seeker 5. Retired 6. Not Seeking Work 7. Full Time Student 8. Long Term Sick / Disabled 9. Child under 16 0. Other Adult

  • 1. Full Time Work (30 hrs or more per week)
  • 2. Part Time Work (less than 30hrs per week)
  • 3. Government Training / New Deal
  • 4. Job Seeker
  • 5. Retired
  • 6. Not Seeking Work
  • 7. Full Time Student
  • 8. Long Term Sick / Disabled
  • 9. Child under 16
  • 0. Other Adult

• How Are They Related To You?

  Select Brother Daughter Father Mother Sister Son Partner Applicant Extended Family Not Related

  • Brother
  • Daughter
  • Father
  • Mother
  • Sister
  • Son
  • Partner Applicant
  • Extended Family
  • Not Related

7th Additional Household Member

• Gender

  Male

  Female

• Title

  Miss

  Mr

  Mrs

  Ms

• First Name(s)

• Last Name

• Date of Birth

  Date

• Nationality

  Select 1. UK National Resident 2. UK National returning from Overseas 3. Czech Republic 4. Estonia 5. Hungary 6. Latvia 7. Lithuania 8. Poland 9. Slovakia 10. Slovenia 11. Other European Economic Area Country 12. Any Other Country 13. Prefer Not To Answer 14. Bulgaria 15. Romania

  • 1. UK National Resident
  • 2. UK National returning from Overseas
  • 3. Czech Republic
  • 4. Estonia
  • 5. Hungary
  • 6. Latvia
  • 7. Lithuania
  • 8. Poland
  • 9. Slovakia
  • 10. Slovenia
  • 11. Other European Economic Area Country
  • 12. Any Other Country
  • 13. Prefer Not To Answer
  • 14. Bulgaria
  • 15. Romania

• Ethnicity

  Select 1. White English, Scottish, Welsh, Northern Ireland, British 2. White Irish 3. Gypsy or Irish Traveller 4. White Other 5. Mixed White and Black Caribbean 6. Mixed White and Black African 7. Mixed White and Black Asian 8. Mixed White and Black Other 9. Asian or Asian British Indian 10. Asian or Asian British Pakistan 11. Asian or Asian British Bangladeshi 12. Asian or Asian British Chinese 13. Asian or Asian British Other 14. Black African, Caribbean or Black British Caribbean 15. Black African, Caribbean or Black British African 16. Black African, Caribbean or Black British Other 17. Other Ethnic Group Arab 18. Other Ethnic Group Other 19. Prefer Not to Answer

  • 1. White English, Scottish, Welsh, Northern Ireland, British
  • 2. White Irish
  • 3. Gypsy or Irish Traveller
  • 4. White Other
  • 5. Mixed White and Black Caribbean
  • 6. Mixed White and Black African
  • 7. Mixed White and Black Asian
  • 8. Mixed White and Black Other
  • 9. Asian or Asian British Indian
  • 10. Asian or Asian British Pakistan
  • 11. Asian or Asian British Bangladeshi
  • 12. Asian or Asian British Chinese
  • 13. Asian or Asian British Other
  • 14. Black African, Caribbean or Black British Caribbean
  • 15. Black African, Caribbean or Black British African
  • 16. Black African, Caribbean or Black British Other
  • 17. Other Ethnic Group Arab
  • 18. Other Ethnic Group Other
  • 19. Prefer Not to Answer

• Religion

  Select 1. Christian 2. Hindu 3. Muslim 4. Sikh 5. Jewish 6. Buddhist 7. No Religion 8. Other 9. Prefer Not to Answer

  • 1. Christian
  • 2. Hindu
  • 3. Muslim
  • 4. Sikh
  • 5. Jewish
  • 6. Buddhist
  • 7. No Religion
  • 8. Other
  • 9. Prefer Not to Answer

• Sexuality

  1. Heterosexual

  2. Gay

  3. Lesbian

  4. Bisexual

  5. Prefer Not to Answer

• Disability

  Select 1. Not Disabled 2. Hearing Disability 3. Mental Health Issues 4. Speech Impediment 5. Learning Disability 6. Mobility Disability 7. Visual Disability 8. Other Disability 9. Prefer Not to Answer

  • 1. Not Disabled
  • 2. Hearing Disability
  • 3. Mental Health Issues
  • 4. Speech Impediment
  • 5. Learning Disability
  • 6. Mobility Disability
  • 7. Visual Disability
  • 8. Other Disability
  • 9. Prefer Not to Answer

• Economic Status

  Select 1. Full Time Work (30 hrs or more per week) 2. Part Time Work (less than 30hrs per week) 3. Government Training / New Deal 4. Job Seeker 5. Retired 6. Not Seeking Work 7. Full Time Student 8. Long Term Sick / Disabled 9. Child under 16 0. Other Adult

  • 1. Full Time Work (30 hrs or more per week)
  • 2. Part Time Work (less than 30hrs per week)
  • 3. Government Training / New Deal
  • 4. Job Seeker
  • 5. Retired
  • 6. Not Seeking Work
  • 7. Full Time Student
  • 8. Long Term Sick / Disabled
  • 9. Child under 16
  • 0. Other Adult

• How Are They Related To You?

  Select Brother Daughter Father Mother Sister Son Partner Applicant Extended Family Not Related

  • Brother
  • Daughter
  • Father
  • Mother
  • Sister
  • Son
  • Partner Applicant
  • Extended Family
  • Not Related

• Family Contact Details / Next of Kin

Contact 1

• Relationship

• Name

• Address

• Telephone Number

• Email Address

Contact 2

• Relationship

• Name

• Address

• Telephone Number

• Email Address

Condition of Property / Reason for Moving

• Please input details of current property and external areas - Note any Damage or recharges

• Immediate Reason for Rehousing

  Select Permanent Decant Other issues with Neighbours Unsuitable due to ill health Can't afford rent / mortgage To move near to work To move to independent accommodation Underoccupying Relationship breakdown (non violent) Racial harassment Unsuitable due to overcrowding Unsuitable due to poor condition To move near family/friends To move near accommodation with support Financial difficulties Domestic Violence Other

  • Permanent Decant
  • Other issues with Neighbours
  • Unsuitable due to ill health
  • Can't afford rent / mortgage
  • To move near to work
  • To move to independent accommodation
  • Underoccupying
  • Relationship breakdown (non violent)
  • Racial harassment
  • Unsuitable due to overcrowding
  • Unsuitable due to poor condition
  • To move near family/friends
  • To move near accommodation with support
  • Financial difficulties
  • Domestic Violence
  • Other

History

• Have you been a Places for People Tenant before?

  Yes

  No

• If yes: address

• Tenancy Start Date

• Tenancy End Date

• Reason for leaving

• Criminal Convictions Declaration

• Do you or any of your household have any criminal convictions which are not spent?

  Yes

  No

• If yes please give details below of: Names of Offender Date of Conviction Offence When will it be spent

• This information may not harm your application. We will keep it strictly confidential

• Have you or anyone in your household had any support needs either current or previous? E.g tenancy related, health or mental health, domestic abuse, parenting, financial, substance/alcohol. <br>If yes please put details below

  Yes

  No

• Details of support needs

• Have you or anyone in your household ever been involved with any support agencies? E.g CMHT, social services, probation, Substance/alcohol services.<br>If yes put any details below

  Yes

  No

• Details of support agencies

• Have you or anyone in your household ever had any convictions? <br>Include details of offender, actual conviction and dates, Cautions, youth convictions, spent convictions, prison sentences, injunction/undertaking breaches<br>If yes put any details below

  Yes

  No

• Details of convictions

• Have you or anyone in your household ever been involved in or investigated for acts of nuisance or anti-social behaviour? (including noise and youth nuisance, contact from landlord, environmental health department or Police)

  Yes

  No

• Details of nuisance/ASB

• Have you or anyone in your household ever been a member of the Armed Forces?

  Yes

  No

• Details of Service

Applicant 1 Received

• Photos of documents

  Media

• Proof of ID

• Proof of Income

• Employment Reference

• Medical Confirmation

• Landlord/Mortgage Ref

• Proof of Residency

• Police Report

• Previous Tenancy/Person Check (AO)

• Passport/Home Office letter or leave to remain

Applicant 1 to follow

• Proof of ID

• Proof of Income

• Employment Reference

• Medical Confirmation

• Landlord/Mortgage Ref

• Proof of Residency

• Police Report

• Previous Tenancy/Person Check (AO)

• Passport/Home Office letter or leave to remain

Applicant 2 Received

• Photos of documents

  Media

• Proof of ID

• Proof of Income

• Employment Reference

• Medical Confirmation

• Landlord/Mortgage Ref

• Proof of Residency

• Police Report

• Previous Tenancy/Person Check (AO)

• Passport/Home Office letter or leave to remain

Applicant 2 to follow

• Proof of ID

• Proof of Income

• Employment Reference

• Medical Confirmation

• Landlord/Mortgage Ref

• Proof of Residency

• Police Report

• Previous Tenancy/Person Check (AO)

• Passport/Home Office letter or leave to remain

Income Details (per week)

• Total Household Income (per week)

• Wage 1

• Wage 2

• Child Benefit

• JSA

• ESA

• Income Support

• DLA (care)/(mob)

• Child Tax Credit

• Working Tax Credit

• Pension Credit

• State Retirement Pension

• Carer's Allowance

• Attendance Allowance

• Statutory Sick Pay (SSP)

• Statutory Maternity Pay (SMP)

• Widows Pension

• Private / Company Pensions

• Incapacity Benefit

• Others Benefits? (Please state)

• Child Maintenance

• Family Contribution

Expenditure Details (per week)

• Total Household Expenditure (per week)

• Mortgage/Rent

• Mortgage Endowment

• Mortgage Arrears

• Secured Loan

• Council Tax

• Buildings Insurance

• Contents Insurance

• Life Insurance

• Personal Pension

• Gas/Electric

• Water Rates

• Telephone

• TV Licence

• Food & Cleaning

• Toiletries

• Tobacco/Alcohol

• Clothing

• Child Maintenance

• School Meals

• Pocket Money

• Travel Expenses

• Car Insurance

• Car Finance

• Servicing/Recovery Service

• Petrol

• Health Costs

• TV / Video Rental

• Monthly Cash Flow Summary

• Total Monthly Income

• Total Monthly Outgoings

• Balance Difference

• Creditor

• Payment Offer

• Account Balance

• Creditor

• Payment Offer

• Account Balance

• Creditor

• Payment Offer

• Account Balance

• Creditor Total Payment Offer

• Creditor Total Account Balance

• Savings (Total)

• I confirm that this is a true record of my financial position, Signed.........

  Sign

Finance Questions

• How will the rent be paid?

• Does the customer have a current bank account?

  Yes

  No

• Guide to the cost of renting your own home given? DATE:

• Affordability discussed

  Yes

  No

• Income and Expenditure Analysis Completed?

  Yes

  No

• If no reason(s) why

Employer Details

Applicant 1

• Employer

• Address/Contact Details

• Length of Time Employed

Applicant 2

• Employer

• Address/Contact Details

• Length of Time Employed

Previous 3 years address/landlord details

• Address

• Date From/To

• Landlord Contact Details

• Reason for Leaving

• Address

• Date From/To

• Landlord Contact Details

• Reason for Leaving

• Address

• Date From/To

• Landlord Contact Details

• Reason for Leaving

• Address

• Date From/To

• Landlord Contact Details

• Reason for Leaving

• Address

• Date From/To

• Landlord Contact Details

• Reason for Leaving

Pets/Furniture

• Any Pets?

  Yes

  No

• Details of any pets

• Does the Applicant have any furniture for the property?

  Yes

  No

• If no, how will they obtain it? (E.g Social Fund Loan/Grant, Credit Union, charity furniture store referral?) - Has advice been given?

• Furniture Package Discussed

  Yes

  No

• Welcome to your home DVD given: DATE:

  Date

Verification

• Applicant Verified By:

• Name

• Job Title - Neighbourhood Officer

• Signature

  Sign

• Date

  Date

• Outstanding Documentation Required

  Yes

  No

• Outstanding Documents Received/Checked by:

• Name

• Job Title -

• Signature

  Sign

• Date

  Date

• Where required the Community Safety Unit has viewed the applicant's details:

• Name

• Job Title -

• Signature

  Sign

• Date

  Date

• CSO Comments (if applicable)

• Additional Notes: (Include points or areas preferred updates)

• React Check:

• How much rent to pay at sign up?

• Disclosure of Interests<br>Is anyone in your household, including close relatives, related to a member of staff, or a member of our customer panels, groups?

  Yes

  No

• If yes:

• Name 1

• Relationship to you

• Do they work for Places for People?

  Yes

  No

• What panel or group do they belong to?

• Name 2

• Relationship to you

• Do they work for Places for People?

  Yes

  No

• What panel or group do they belong to?

Data Protection Fair Processing Notice - Please Read Carefully

• The information you provide on this form will be used for housing management purposes and for statistical analysis. We are committed to handling data in line with the Data Protection Act 1998 and will treat your information with the highest level of security and confidentiality.
  
  We will verify the information and may check it with, or pass it on to, organisations such as:
  
  Current/former landlords
  Credit reference agencies
  Bank/building societies
  Local councils
  Doctors
  Health Services
  Social Services
  Police
  Voluntary Services
  Other organisations as appropriate
  
  We may also utilise other company's data to carry out research so that we can tailor our services, run credit checks or for debt recovery purposes.
  
  If any of the information you give on this form is false or wrong, we may reject your application. If we find out after you have been given a home, we may evict you.
  
  (Where a landlord has granted a tenancy as a result of a false statement made knowingly or recklessly by the tenant, this is a ground on which the landlord can seek possession of the premises from schedule 2 of the Housing Act 1988.)
  
  By signing this form you consent to us processing your personal information and agree to us sharing with organisations as above.

• Customer's Signature

  Sign

• Print Name

• Date signed

  Date

• Joint Applicant's Signature

  Sign

• Print Name

• Date signed

  Date

• We may share your personal information with other companies in our group. We and the other group companies may send you information by post or email about products and services that we think will be of interest to you. If you would rather that we did not do this please tick the box or contact us at any time.

If Applicant is Being Recommended for Rejection

• Reason

• Date Sent

  Date

• To

• Outcome

• Approval / Rejection Letter Sent

  Date

• Date

  Date

For Sign Up

• Tenancy Start Date

  Date

• Property Ref

• Tenancy Ref

• Band

  A

  B

  C