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.
| Question | Answer |
|---|---|
| Form Name | Homechoice Application Form |
| Form Length | 12 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 3 min |
| Other names | home choice plus application form online, homechoice catalogue 2021 pdf, homechoice online application, homechoice order form |
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.
telephone West Norfolk Homechoice on 01553 616678.
For office use only |
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Date received: |
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Registration No: |
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Medical Form received: |
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SN Form received: |
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Relevant date: |
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Banding: |
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Section A: About You – Please complete in BLOCK CAPITALS |
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First applicant |
Joint applicant |
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(if you are making a joint application) |
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Surname |
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First Names |
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Ms/Mrs/Miss/Mr |
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Date of birth |
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National Insurance |
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Number |
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Contact address |
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Home telephone |
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Mobile telephone |
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Messages can be left |
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For me at this number |
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Have you ever been |
YES |
NO |
YES |
NO |
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known by another name? |
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If yes, what |
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was your name? |
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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 |
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Do you have a permanent right of residence in the UK? |
YES |
NO |
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If no, please provide copies of your passport and entry visas. |
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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 |
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Income details |
First applicant |
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Joint applicant |
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Per week |
or month |
Per week |
or month |
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Gross pay (before deductions |
£ |
£ |
£ |
£ |
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for Tax & National Insurance |
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Income Support |
£ |
£ |
£ |
£ |
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Incapacity Benefit |
£ |
£ |
£ |
£ |
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Child Benefit |
£ |
£ |
£ |
£ |
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Other state benefits |
£ |
£ |
£ |
£ |
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(e.g. Working Families Tax Credit) |
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State pension |
£ |
£ |
£ |
£ |
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Occupational pension |
£ |
£ |
£ |
£ |
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Maintenance |
£ |
£ |
£ |
£ |
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Total Income |
£ |
£ |
£ |
£ |
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Savings & Investments |
£ |
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(Total joint amount to the nearest £100) |
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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 |
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Have you placed your |
Yes |
No |
your property |
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home for sale? |
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Total mortgage |
£ |
Monthly mortgage payments |
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you owe |
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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 |
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Tenant of a private landlord |
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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? |
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Yes |
No |
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If above ground floor, which level? |
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Is there a lift? |
Yes |
No |
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Do you have a garden/yard? |
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Yes |
No |
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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) |
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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 |
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Have you been asked to leave your current home? |
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Have you been served with a Notice to Quit or a Notice of Seeking |
Yes |
No |
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Possession? |
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Has a court served you with a Possession Order? |
Yes |
No |
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Please tell us why you can no longer stay in your present home |
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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
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 |
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Have you been living in the Borough for more than 3 years? |
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Local connection to a village within the district of West Norfolk |
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Do you have a local connection with any of the villages in the district of |
Yes |
No |
West Norfolk? |
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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 |
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that you need. |
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If you are currently a Housing Association tenant would you be interested |
Yes |
No |
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in a Mutual Exchange? (see the Guide to West Norfolk Homechoice). |
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Section F: Confidential disclosure
Failure to complete and sign this section will prevent us from considering your application to join the register.
Unacceptable/inappropriate
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 |
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2 |
Breach of tenancy conditions |
Yes |
No |
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3 |
Conduct causing or likely to cause a nuisance or annoyance to persons in the |
Yes |
No |
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locality |
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4 |
Conviction for using the property for an immoral or illegal purpose |
Yes |
No |
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Conviction for an arrestable offence committed in the property or in the locality |
Yes |
No |
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of the property |
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6 |
Yes |
No |
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to violence or threats of violence |
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7 |
Deterioration in the condition of the property |
Yes |
No |
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8 |
A false statement which induced the landlord to grant the tenancy |
Yes |
No |
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9 |
The charge of or paying a premium on an exchange of a tenancy |
Yes |
No |
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10 Inappropriate conduct in respect of the property if the property was occupied |
Yes |
No |
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as an employee of the landlord |
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Sex offenders |
Yes |
No |
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Do you or a member of your household appear on the Sex Offenders register? |
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If you answered yes above, what is the name of the person on the register? |
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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 |
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Date |
signature |
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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 |
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Irish |
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Any other White background please state |
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Mixed |
White and Black Caribbean |
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White and Black African |
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White and Asian |
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Any other Mixed background, please state |
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Asian or Asian British |
Indian |
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Pakistani |
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Black or Black British
Chinese or other ethnic group
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Bangladeshi |
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Any other Asian background, please state |
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Caribbean |
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African |
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Any other Black background, please state |
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Chinese |
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Any other, please state |
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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 |
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Religion/Belief |
Please tick one box. |
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No religion |
Christian |
Buddhist |
Hindu |
Jewish |
Muslim |
Sikh |
Other (please write in) |
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........................................................................ |
Disability - Do you consider yourself to be disabled?
If yes please tick the boxes below that apply to you.
Yes
No
Mobility |
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Hearing impairment |
Mental health condition
Visual impairment |
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Learning difficulty |
Other
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 |
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Portuguese |
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Podaj Twój ojczysty język? |
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Naszym celem jest zapewnienie naszym klientom serwisu na najwyższym poziomie. |
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Polish |
W tym celu prosimy o określenie ojczystego języka. |
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Jeśli angielski nie jest Twoim ojczystym językiem, proszę zaznaczyć najbardziej |
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odpowiednie dla państwa: |
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angielski w mowie rozumiany |
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pisany angielski rozumiany |
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Kokia yra Jūsų Gimtoji kalba? |
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Lithuanian |
Siekiant pagerinti klientų aptarnavimo kokybę, mes būtume dėkingi jeigu Jūs |
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informuotumete kokia yra Jūsų gimtoji kalba. |
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Jeigu anglu kalba nėra Jūsų Gimtoji kalba, prašome pažymėti jeigu Jūs galite: |
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Suprasti šnekamąją anglų kalba |
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Suprasti rašytinę anglų kalbą |
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Kadu jūsu pirmo valoda? |
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Latvian |
Mes loti velamies, lai mūsu pakalpojumi tiek sniegti klientiem vispiemerotakaja. Šim |
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nolūkam mes būtu pateicigi, ja jūs varetu noradit savu pirmo valodu. |
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Ja jūsu valoda nav anglu, lūdzu noradiet atzimejot lodzinu, ja jūs varat: |
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Suprast runato anglu |
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Suprast ranstveida anglu |
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11
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West Norfolk Homechoice |
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Housing Services |
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Borough Council of King’s Lynn & West Norfolk |
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King’s Court, Chapel Street, King’s Lynn, Norfolk PE30 1EX |
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Tel: (01553) 616678 Fax: (01553) 768999 |
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DX57825 King’s Lynn |
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