Application Form
Menu

Application for Accommodation in England and Wales

  1. Please ensure that you have all the information required before completing this form as must be completed in one go.

    You will need your NI Number, details of current and previous addresses, next of kin information, employment information and details of any Benefit Claims
  2. Property Applying for*
    Please enter a value
  3. 1. Applicant’s Personal Details
  4. Title*
    Invalid Input
  5. Your Full Name*
    Please type your full name.
  6. Date of Birth*

    Invalid Input
  7. Place of Birth*
    Please enter a value for this field
  8. National Insurance Number*
    Please enter a value for this field
  9. Phone (daytime)*
    Please type your phone number.
  10. Mobile*
    Please type your phone number.
  11. Email*
    Invalid email address.
  12. Have you ever been known by any other name?*
    Please enter a value for this field
  13. If yes, please provide details and dates:
    Invalid Input
  14. 2. Other persons whom will Be Residing At The Property (Please Include All Children)
  15. Extra Occupant 1 Title
    Invalid Input
  16. Extra Occupant 1 Full Name
    Please type your full name.
  17. Extra Occupant 1 Date of Birth

    Invalid Input
  18. Extra Occupant 1 Place of Birth
    Please type your full name.
  19. Extra Occupant 2 Title
    Invalid Input
  20. Extra Occupant 2 Full Name
    Please type your full name.
  21. Extra Occupant 2 Date of Birth

    Invalid Input
  22. Extra Occupant 2 Place of Birth
    Please type your full name.
  23. Extra Occupant 3 Title
    Invalid Input
  24. Extra Occupant 3 Full Name
    Please type your full name.
  25. Extra Occupant 3 Date of Birth

    Invalid Input
  26. Extra Occupant 3 Place of Birth
    Please type your full name.
  27. Extra Occupant 4 Title
    Invalid Input
  28. Extra Occupant 4 Full Name
    Please type your full name.
  29. Extra Occupant 4 Date of Birth

    Invalid Input
  30. Extra Occupant 4 Place of Birth
    Please type your full name.
  31. 2. Please supply your current and previous address
  32. Current Address*
    Please enter a value
  33. Postcode*
    Please enter a value
  34. Lived there from/to*
    Please enter a value
  35. Landlord's Name
    Please enter a value
  36. Landlords Tel. No
    Please type your full name.
  37. Landlord's Email
    Invalid email address.
  38. Previous Address
    Please type your full name.
  39. Postcode
    Please type your postcode
  40. Lived there from/to
    Please enter a value
  41. Landlord's Name
    Please enter a value
  42. Landlords Tel. No
    Please enter a value
  43. Landlord's Email
    Invalid email address.
  44. 4. Contacts
  45. Next of Kin: (or person to be contacted in the event of an emergency)*
    Please enter a value
  46. Relationship*
    Please enter a value
  47. Their address*
    Please enter a value
  48. Postcode*
    Please enter a value
  49. Telephone Daytime*
    Please enter a value
  50. Telephone Evening*
    Please enter a value
  51. Doctor’s Name
    Please enter a value
  52. Doctor's Address
    Please enter a value
  53. Doctor's Postcode
    Please enter a value
  54. Doctors's Telephone
    Please enter a value
  55. 5. Employment
  56. Name of employer: (or last employer)*
    Please enter a value
  57. Employer Address*
    Please enter a value
  58. Employer Postcode*
    Please enter a value
  59. Your job/title or description*
    Please enter a value
  60. Name of your work supervisor*
    Please enter a value
  61. Telephone No*
    Please enter a value
  62. Email*
    Invalid email address.
  63. Dates of Employment: From - to*
    Please enter a value
  64. Salary*
    Please enter a value
  65. Are your employment circumstances likely to change in the period of the tenancy/the next year?(*
    Invalid Input
  66. If yes, please provide details
    Invalid Input
  67. 6. Housing Benefit / Local Housing Allowance
  68. Are you claiming Housing Benefit / Local Housing Allowance? *
    Please specify a value
  69. If yes, please provide: Date of Last claim
    Please enter a value
  70. Name of Local Authority
    Please enter a value
  71. If no, but you do intend to, what forms of identification verification do you intend to produce?
    Invalid Input
  72. 6a. Additional Financial Information
  73. Retirement Pension
    Please enter a value
  74. Other Income
    Please enter a value
  75. 7. Other
  76. Do you have any pets? *
    Please specify a value
  77. If yes, please detail
    Invalid Input
  78. Do any of the proposed occupants smoke? *
    Please specify a value
  79. 8. Applicant's Consent
    I hereby expressly consent to my personal details including any forwarding address at the termination of any tenancy being passed to the landlord and/or to the utility company and/or to the local authority. I understand that other than for reasons outlined above, all information will be treated as confidential.
  80. Signature (Please print your full name)*
    Please enter a value
  81. Date

    Invalid Input
  82. 9. Declaration
    11.1. I am applying for a tenancy on the basis that the property or accommodation will be my main or only home.
    11.2. I give permission for enquiries to be made based on the information I have provided to establish my status.
    11.3. I also certify that I do not
    • have any County Court Judgements against me
    • owe money to any Housing Benefit Department or any Local Authority
    • owe monies or dilapidation monies to any previous Landlord
    • have substance or alcohol abuse problems.
  83. Signature (Please print your full name)*
    Please enter a value
  84. Date

    Invalid Input
  85. IF YOU KNOWINGLY SUPPLY FALSE INFORMATION IT MAY BE USED BY THE LANDLORD TO SEEK POSSESSION OF THE PROPERTY UNDER GROUND 17 OF SECTION 8 OF THE HOUSING ACT 1988 (AS AMENDED BY SECTION 102 OF THE HOUSING ACT 1996). The information on this form is for the sole use of the landlord only for the purposes of letting. No information contained therein will be divulged to any third party, unless the Tenant defaults.