Please complete a separate form for each applicant.
N/ABridge ViewBrook ViewDaltons WayFarington MewsHalf Penny MeadowsLichfield GrangeLockside WalkPark ViewThe AldersWoodcroft Corner
Is this a joint application? YesNo
If NOT lead applicant, please complete
Relationship to lead applicant:
Are you receiving any of the following:
—Please choose an option—Housing benefitUniversal Credit housing elementNeitherDon't know
Is a mortgage required?
Are you contributing to mortgage?
Is your income being used for the mortgage application?
Please provide your gross annual income (i.e. salary before tax) plus annual amount of benefits, universal credits or pensions and income from investments:
Current household savings (including deposit):
Scheme type: —Please choose an option—Shared ownershipOlder People's Shared Ownership (OPSO)Rent to Buy
Reason for applying: —Please choose an option—First-time buyerRelationship breakdownUnable to buy without assistanceOver 55 and living in unsuitable accommodationOther
If other, please specify:
Is your gross annual household income less than £80,000? YesNo
Have you previously been a homeowner? YesNo
Do you currently have a property to sell? YesNo
If YES, what is the status?
—Please choose an option—Sale agreed and proceedingOn the marketNot on the market
Applicant lived here less than 3 years? YesNo
Date of birth
National Insurance Number
—Please choose an option—MarriedWidowedDivorcedSeparatedSingle
—Please choose an option—MaleFemaleOtherPrefer not to say
Is gender identity the same as sex assigned at birth?
—Please choose an option—HeterosexualHomosexualBisexualOther sexual orientationPrefer not to say
—Please choose an option—ChristianBuddhistHinduJewishMuslimSikhNo religionOther religionPrefer not to say
Do you require a wheelchair
Ethnicity:—Please choose an option—UKRepublic of IrelandEuropean Economic Area, excluding Ireland (EEA includes member states of the EU, plus Iceland, Liechtenstein and Norway).Other
Preferred method of communication:
Other method of communication:
Are you a British citizen?
If above is No, please advise: Do you have indefinite leave to remain in the UK?
Are you a member of the armed forces?
A surviving partner of a member of the armed forces?
Bereaved in the last 24 months?
Honourably discharged in the last 24 months?
Please select from below
—Please choose an option—Local authority tenantPrivate registered provider or housing association tenantPrivate tenantOwner occupierTied home or renting with jobLiving with family or friendsTemporary accommodationOtherDon't know
Are you currently a tenant?
Are you a local authority tenant?
(*If YES, please also complete the Tenancy section)
Are you in rent arrears?
Do you have a history of rent arrears?
Rent arrears details:
Please select from below
—Please choose an option—Full time (30 hours+)Part time (Fewer than 30 hours)In government training into workJobseekerRetiredNot seeking workFull-time studentUnable to work due to long-term sickness or disability
Length of employment:
Local authority you live in:
Local authority you work in:
Number of adults:
Number of Children:
*Please provide a description
Are you currently a private registered, housing association or local authority tenant?
If YES, please complete the following section
What is the property type?
—Please choose an option—Flat or MaisonetteBedsitHouseBungalowOther
How many bedrooms do you have?
—Please choose an option—Social rentAffordable rentPrivate rentOther
Have you been asked to provide a supporting statement? YesNo
If YES, please provide below