Homechoice Application Form PDF Details

The Homechoice Application form serves as an integral step for individuals seeking to enter the West Norfolk Homechoice Housing Register, aligning with the revised June 2013 guidelines. This comprehensive document requires applicants to provide extensive details about themselves and any joint applicants, including personal information, current living circumstances, and specific housing needs. It also critically addresses the financial status of applicants, asking for a detailed account of income, benefits, and any owned properties. Applicants are prompted to disclose their employment details, and for those with medical conditions, disabilities, or care needs, there's a section dedicated to explaining how these aspects impact their housing requirements. The form equally delves into applicants' housing history over the past six years, offering insights into their previous living arrangements and reasons for moving. Importantly, the form begins with a strong advisory for applicants to read the 'Guide to West Norfolk Homechoice' thoroughly before proceeding with their application. It is made clear that those considering shared ownership or other affordable housing options should request a separate form, emphasizing the form's role as a gateway to a range of housing solutions within the region. Assistance in completing the form is available, ensuring that all potential applicants can navigate the process with support, making the journey towards securing suitable housing as smooth as possible.

QuestionAnswer
Form NameHomechoice Application Form
Form Length12 pages
Fillable?No
Fillable fields0
Avg. time to fill out3 min
Other nameshome choice plus application form online, homechoice catalogue 2021 pdf, homechoice online application, homechoice order form

Form Preview Example

Application Form for the West Norfolk Homechoice Housing Register

Revised June 2013

Please read the ‘Guide to West Norfolk Homechoice’ before you fill in this form.

If you also want to be considered for shared ownership or other affordable options to buy, you should ask for another form: ‘West Norfolk Homechoice Low Cost Home Ownership’.

Please complete the form in full and return it to West Norfolk Homechoice, Housing Services,

Borough Council of King’s Lynn & West Norfolk, King’s Court, Chapel Street, King’s Lynn, Norfolk PE30 1EX. www.west-norfolk.gov.uk If you need help or advice completing the form, please

telephone West Norfolk Homechoice on 01553 616678.

For office use only

 

 

 

 

 

 

 

 

 

 

 

 

Date received:

 

 

Registration No:

 

Medical Form received:

 

 

 

 

 

 

 

SN Form received:

 

 

Relevant date:

 

Banding:

 

 

 

 

 

 

 

Section A: About You – Please complete in BLOCK CAPITALS

 

 

 

 

 

 

First applicant

Joint applicant

 

 

 

 

 

(if you are making a joint application)

 

 

 

 

 

 

 

Surname

 

 

 

 

 

 

 

 

 

 

 

 

 

First Names

 

 

 

 

 

 

 

 

 

 

 

 

 

Ms/Mrs/Miss/Mr

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of birth

 

 

 

 

 

 

 

 

 

 

 

 

 

National Insurance

 

 

 

 

 

 

Number

 

 

 

 

 

 

 

 

 

 

 

 

 

Contact address

 

 

 

 

 

 

 

 

 

 

 

 

 

Home telephone

 

 

 

 

 

 

 

 

 

 

 

 

 

Mobile telephone

 

 

 

 

 

 

 

 

 

 

 

 

 

Messages can be left

 

 

 

 

 

 

For me at this number

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you ever been

YES

NO

YES

NO

known by another name?

 

 

 

 

 

 

 

 

 

 

 

 

 

If yes, what

 

 

 

 

 

 

was your name?

 

 

 

 

 

 

 

 

 

 

 

 

 

Returning from abroad

Have you or any joint applicants applying with you arrived in or returned to the UK in the last 5 years, after living abroad?

YES

NO

If yes please give details

1

Are you subject to immigration control?

YES

NO

 

 

 

 

Do you have a permanent right of residence in the UK?

YES

NO

If no, please provide copies of your passport and entry visas.

 

 

 

 

 

Section B: Details of everyone who will live with you in your new home

Please do not include yourself or any joint applicant.

Surname

First names

Date of birth

Relationship to you

Male/ Female

Are they living with you now?

If anybody mentioned above is not living with you now, please give the following details:

Name

Address

Why do they live elsewhere now?

Pregnancy - Are you, or any of the people mentioned in Section A or B, pregnant?

Yes

No

If yes, who is pregnant?

Name

When is the baby due?

Please provide proof of pregnancy from a midwife, hospital or doctor.

Medical problems - Please tell us below about anyone with medical problems or

disability who will be living with you and about how their current accommodation causes them problems.

Name

Medical problem/disability

How current accommodation affects them

Does anyone listed in Section A or B use a wheelchair?

Yes

No

Care and support needs - Does anyone listed in Section A or B need care or other support from health, social services or an independent care agency?

Yes

No

If yes, please give details below.

2

Employment details

Employer’s name and address

Do you work full time/ part time?

First applicant

Joint applicant

 

 

 

 

 

 

 

 

 

Income details

First applicant

 

Joint applicant

 

Per week

or month

Per week

or month

 

 

 

 

 

 

Gross pay (before deductions

£

£

£

£

for Tax & National Insurance

 

 

 

 

 

 

 

 

 

Income Support

£

£

£

£

 

 

 

 

 

Incapacity Benefit

£

£

£

£

 

 

 

 

 

Child Benefit

£

£

£

£

 

 

 

 

 

Other state benefits

£

£

£

£

(e.g. Working Families Tax Credit)

 

 

 

 

 

 

 

 

 

State pension

£

£

£

£

 

 

 

 

 

Occupational pension

£

£

£

£

 

 

 

 

 

Maintenance

£

£

£

£

 

 

 

 

 

Total Income

£

£

£

£

 

 

 

 

 

Savings & Investments

£

 

 

 

(Total joint amount to the nearest £100)

 

 

 

 

Please remember to attach proof of your household income and identity

e.g. passport or birth certificate, for each member of your household

If you are an owner or part owner of a property (house, caravan, boat) here or abroad? If yes, please give the address and complete the boxes below.

Address

Estimated value of

£

Have you placed your

Yes

No

your property

 

home for sale?

 

 

 

 

 

 

 

 

Total mortgage

£

Monthly mortgage payments

£

 

you owe

 

 

 

 

 

 

 

 

 

Section C: Housing history

Where have you been living in the past 6 years. Please give details of where you and the joint applicant have been living during the last 6 years.

Applicant (please give your current address first) (continue over page)

Address

Name & address of the landlord/owner

Were you a tenant, lodger or owner

Date in

Date out

Reason for leaving

3

Address

Name & address of the landlord/owner

Were you a tenant, lodger or owner

Date in

Date out

Reason for leaving

Joint Applicant

Address

Name & address of the landlord/owner

Were you a tenant, lodger or owner

Date in

Date out

Reason for leaving

Do you or does anyone who will live with you, owe money to any current or previous landlord?

Yes

No

If yes, please give the name and address of the former landlord and say how much you owe.

4

If yes, please give the name and address of the former landlord and say how much you owe.

Amount owing £

Address

Amount owing

£

Address

Section D: Why you want to move

Your current home

Please tick one box below to show your current housing situation

Tenant of a Housing Association

 

Tenant of a private landlord

 

 

 

Owner occupier

Living with parents

Living with family

(grandparents,child,grandchild,brother,sister, uncle,aunt,nephew or niece)

Living with friends or lodging Hostel or refuge Homeless/no fixed address

Tenant of another council

Supported housing

Bed & breakfast

Hospital or nursing home

Prison

Armed forces accommodation

Other (Please give details)

...............................................................

Type of property you are currently living in (please tick as appropriate)

House

Bungalow

Maisonette

Flat

Other

Please describe..........................................................................................

If you live in a flat or maisonette, is it on the ground floor?

 

Yes

No

 

 

 

 

 

If above ground floor, which level?

 

Is there a lift?

Yes

No

 

 

 

 

 

Do you have a garden/yard?

 

Yes

No

 

 

 

 

 

Please give details of the number and size of the bedrooms in your current home and who sleeps there, following the example given in the first box below.

Bedroom

Size (e.g. 10 feet x 12 feet) Who sleeps there (give name, age and relationship to you)

 

 

 

1

10 feet x 12 feet

Alan Smith, Aged 9, Son

5

Facilities in your home

Do you share any of the following facilities with anybody that is not a member of your family (i.e. parent, grandparent, child, grandchild, brother, sister, uncle, aunt, nephew or niece)? Please tick the appropriate box.

Kitchen

Bath or shower

Toilet

If you are lacking any of the above facilities or if your home is in serious disrepair please give details.

Security of tenure

Yes

No

Have you been asked to leave your current home?

 

 

 

 

 

Have you been served with a Notice to Quit or a Notice of Seeking

Yes

No

Possession?

 

 

 

 

 

Has a court served you with a Possession Order?

Yes

No

 

 

 

Please tell us why you can no longer stay in your present home

 

 

Please tell us why you want to move, for example to be nearer your family, for work reasons or because of any problems you have. Please attach any supporting evidence or copies of documents , such as a social worker’s report or a letter from your employer.

Section E: About the property you would like to rent

The property adverts are placed in the Property Section of the Friday edition of the Lynn News, on our website www.west-norfolk.gov.uk, and at the Council’s offices in King’s Lynn, Downham Market and Hunstanton. The Guide to West Norfolk Homechoice provides you with information on how to bid for properties. If you think that you will need special help to find the adverts and making bids for properties, please tell us why below.

6

Is there anybody that you would like us to be able to discuss your application with (this may be a friend, relative or professional worker)?

Yes

No

Name

Telephone number

Relationship to you

e.g. friend, social worker

Local connection to the Borough of King’s Lynn & West Norfolk

Yes

No

 

Have you been living in the Borough for more than 3 years?

 

 

 

 

 

Local connection to a village within the district of West Norfolk

 

 

Do you have a local connection with any of the villages in the district of

Yes

No

West Norfolk?

 

 

 

 

 

If so, please tell us what the connection is, below. The Guide to West Norfolk Homechoice tells you what we mean by ‘local connection’.

Name of village

Connection

Where would you like to live

West Norfolk Homechoice allows you to apply for advertised properties anywhere in the Borough. To help us plan housing for the future, please indicate below where you would most like to be housed.

What kind of home would you like

To help us plan housing for the future please tick below the type of home you would prefer.

House

Maisonette

Flat

Sheltered accommodation for over 60s

Bungalow

Housing with care for the frail elderly (for those with significant care needs as assessed by Social Services)

Accommodation adapted for the disabled (e.g. for a wheelchair, level access shower)

If you use a wheelchair please tick the appropriate box.

Both inside and outside the home

Inside only

Outside only

Please tick the number of bedrooms

One

Two

Three

Four

Five

 

that you need.

 

 

 

 

 

If you are currently a Housing Association tenant would you be interested

Yes

No

in a Mutual Exchange? (see the Guide to West Norfolk Homechoice).

 

 

7

Section F: Confidential disclosure

Failure to complete and sign this section will prevent us from considering your application to join the register.

Unacceptable/inappropriate (anti-social behaviour)

Have you (or a member of your household) ever been guilty of the following offences or evicted from your property or threatened with eviction on the following grounds:-

Please tick where appropriate.

1

Rent arrears

Yes

No

 

 

 

 

2

Breach of tenancy conditions

Yes

No

 

 

 

 

3

Conduct causing or likely to cause a nuisance or annoyance to persons in the

Yes

No

 

locality

 

 

 

4

Conviction for using the property for an immoral or illegal purpose

Yes

No

 

 

 

 

5

Conviction for an arrestable offence committed in the property or in the locality

Yes

No

 

of the property

 

 

 

6

Under-occupation of the property following the breakdown of a relationship due

Yes

No

 

to violence or threats of violence

 

 

7

Deterioration in the condition of the property

Yes

No

 

 

 

 

8

A false statement which induced the landlord to grant the tenancy

Yes

No

 

 

 

 

9

The charge of or paying a premium on an exchange of a tenancy

Yes

No

 

 

 

10 Inappropriate conduct in respect of the property if the property was occupied

Yes

No

 

as an employee of the landlord

 

 

 

Sex offenders

Yes

No

Do you or a member of your household appear on the Sex Offenders register?

 

 

If you answered yes above, what is the name of the person on the register?

 

 

Please give the expiry date of the register entry.

Help West Norfolk Homechoice to help you

If you have answered ‘yes’ to any of the questions in this confidential disclosure West Norfolk Homechoice will need to consider and investigate the information you have given. This does not automatically mean that you will be unable to join the Housing Register or be given lower priority. If you have answered ‘yes’ to any of the above questions please give details below, including addresses, owner of the property and any relevant dates. Please give below any information to support your belief that your circumstances or behaviour has changed and which you would like to be taken into account.

Support needs

If you think that you may need assistance in helping you to keep to your side of a tenancy agreement, please tell us so that we can advise your future landlord. This will enable them to try and arrange appropriate support for you. Please tell us in the box below what your support needs are.

8

Declaration and Warning

I authorise West Norfolk Homechoice to make any enquiries necessary to check the information I have given on this form and to pass on details of any housing support needs to any future landlord. I will tell West Norfolk Homechoice in writing of any change in my housing circumstances and will complete a new application form if I change my address. All the information given on this form is a full statement of my/our circumstances and all the details are true and complete. I authorise West Norfolk Homechoice to provide a copy of this application form to any of its partner landlords when being considered by them for an offer of accommodation. I understand that if I am made an offer of accommodation as a result of a false or misleading statement, the landlord may withdraw the offer and take legal action to end any tenancy that I/we have already signed for.

Your signature

Date

Joint applicant’s

 

Date

signature

 

 

 

 

 

Please make sure that both applicants (if applicable) sign the declaration.

Data protection

West Norfolk Homechoice will use your information for Housing Register purposes. We may share the information you have provided with government agencies/departments, local authorities and registered social landlords to check the accuracy of the information, as permitted by law. The Council, in order to protect public funds that they handle may use the information on this form to prevent and detect fraud and may share it with other organisations for that purpose. You have a right to ask for a copy of the information we hold on you, which is subject to the Data Protection Act 1998 (for which a small charge will be made) and to correct any inaccuracies.

Equal opportunities monitoring

We aim to treat all applicants fairly. To ensure that West Norfolk Homechoice and partner Housing Associations do not discriminate against anyone we need to collect information from everyone who applies for housing. The information you provide will be kept confidential and only used for monitoring purposes. You do not have to answer the questions if you prefer not to.

Documents

Please remember to enclose the documents we have asked for, if appropriate: Proof of pregnancy - including due date

Copies of your passport and entry visas

Evidence or copies of documents showing why you need to move Worker Registration documents/Residence permit

Most recent wage slip/proof of benefits

Please note that failure to provide all appropriate documentation may result in your application being cancelled or receiving less priority

9

Ethnic Origin Please tick the group that best describes your household.

White

British

 

 

Irish

 

 

Any other White background please state

.........................

Mixed

White and Black Caribbean

 

 

White and Black African

 

 

White and Asian

 

 

Any other Mixed background, please state

Asian or Asian British

Indian

 

 

Pakistani

 

Black or Black British

Chinese or other ethnic group

 

Bangladeshi

 

 

 

.........................

Any other Asian background, please state

 

Caribbean

 

 

 

 

African

 

 

 

 

 

 

 

.........................

Any other Black background, please state

 

Chinese

 

 

 

 

 

.........................

Any other, please state

Gypsy/Traveller

If you are a gypsy or traveller please indicate what type. Tick any that apply

Romany

Irish

Gypsy

Traveller

New Age

Sexuality Please tick one box.

Bisexual

Heterosexual straight

Gay man

Lesbian

 

 

 

 

Religion/Belief

Please tick one box.

 

 

No religion

Christian

Buddhist

Hindu

Jewish

Muslim

Sikh

Other (please write in)

 

 

 

........................................................................

Disability - Do you consider yourself to be disabled?

If yes please tick the boxes below that apply to you.

Yes

No

Mobility

 

Hearing impairment

Mental health condition

Visual impairment

 

Learning difficulty

Other long-standing illness or health condition

10

What is your first language?

We are keen to ensure our services are provided to customers in the most appropriate manner. For this purpose we would be grateful if you could state your first language.

If your first language is not English, please indicate by ticking the box, if you can

understand spoken English

understand written English

(this question is reproduced in the five other languages most commonly spoken in West Norfolk below)

Russian

 

 

 

 

 

 

 

 

 

 

 

Portuguese

 

 

 

 

 

 

 

 

 

 

 

 

Podaj Twój ojczysty język?

 

 

Naszym celem jest zapewnienie naszym klientom serwisu na najwyższym poziomie.

Polish

W tym celu prosimy o określenie ojczystego języka.

 

Jeśli angielski nie jest Twoim ojczystym językiem, proszę zaznaczyć najbardziej

odpowiednie dla państwa:

 

 

 

 

 

 

angielski w mowie rozumiany

 

pisany angielski rozumiany

 

 

 

 

 

 

 

 

 

 

 

Kokia yra Jūsų Gimtoji kalba?

 

Lithuanian

Siekiant pagerinti klientų aptarnavimo kokybę, mes būtume dėkingi jeigu Jūs

informuotumete kokia yra Jūsų gimtoji kalba.

 

Jeigu anglu kalba nėra Jūsų Gimtoji kalba, prašome pažymėti jeigu Jūs galite:

 

 

Suprasti šnekamąją anglų kalba

 

Suprasti rašytinę anglų kalbą

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Kadu jūsu pirmo valoda?

 

Latvian

Mes loti velamies, lai mūsu pakalpojumi tiek sniegti klientiem vispiemerotakaja. Šim

nolūkam mes būtu pateicigi, ja jūs varetu noradit savu pirmo valodu.

Ja jūsu valoda nav anglu, lūdzu noradiet atzimejot lodzinu, ja jūs varat:

 

 

 

 

 

 

 

 

 

 

 

 

 

Suprast runato anglu

 

Suprast ranstveida anglu

 

 

 

 

 

 

11

 

 

 

 

 

 

West Norfolk Homechoice

 

 

 

 

 

 

 

 

 

Housing Services

 

 

 

 

 

 

Borough Council of King’s Lynn & West Norfolk

 

 

 

 

 

 

www.west-norfolk.gov.uk

 

 

 

King’s Court, Chapel Street, King’s Lynn, Norfolk PE30 1EX

 

 

 

Tel: (01553) 616678 Fax: (01553) 768999

1134-02-17

 

 

 

 

 

DX57825 King’s Lynn