fce

use

onl

y Applicant’s name Application date

Application number

Applicant’s address TA TR HR

For

of

1st 1st 1st

Update Update Update

Date in bandBAND A B C D E F MX

Form B

Application for housing Please refer to the qualifcation criteria on form A before applying for housing

Please fll in this form if you want to • rent a home from the council• rent a home from a housing association in Stevenage• move, and you are already a Stevenage Borough council tenant• move, and you are a housing association tenant living in Stevenage• apply to mutual exchange into Stevenage and you don’t currently

live here• apply to mutual exchange within Stevenage and you are a housing

association tenant living in Stevenage

Completing this form The information you give in this form allows us to assess • whether you are eligible or qualify to join our housing register• the housing needs of you and the other people included in this application

It is important that you • give as much information as possible• answer all the questions that apply to you and your household• provide original documents requested

Once you have completed the form you and any second applicant must sign and date the form. We will register your application form from the date you provide all the information we need.

If this form is not complete or is unsigned, it cannot be processed and will be sent back to you. If you do not provide the documents we have asked for, this will delay your application.

If you need help flling in this form, please contact our Customer Service Centre by telephone on 01438 242666 or by textphone on 01438 242555

Please tick box to confrm you have read the above

Title

First name

Last name

Relationship to you

Address with postcode

Phone

You Second applicant Do you have anybody who helps you with housing issues?

Yes No Yes No

If yes, and you are willing to let us contact them about your housing application, please give their details.

Confdentiality, data protection and information sharing The information, personal data and documents you provide are confdential and subject to the requirements of the General Data Protection Regulation (Data Protection Act 2018). It will be kept in paper, electronic or computerised fles. It will be held and processed by Stevenage Borough Council to:

• assess your eligibility and qualifcation for social housing• assess your household’s housing needs• produce statistical data on housing need• prevent and detect housing fraud• safeguard and protect children and vulnerable adults

For the purpose of fulflling our statutory housing duties and powers we may share your information, personal data and documents with other council departments and external agencies and individuals that help us process your application, or that provide accommodation, housing support or welfare services. We may share your information for the purpose of preventing and detecting crime including housing fraud.

If yes, please give us the other name.

Have you ever been known by any other name?

Yes No Yes No

You Second applicant

Name

Address with postcode

If no fxed abode please write ‘NFA’ and provide a ‘care of’ address

National Insurance Number

Mobile phone

Home phone

Work phone

Email address

Part 1: name and address

Please use this section to tell us about you, where you live now and how we can contact you.

Name

You Second applicant

Single

Married

Civil partner

Living together

Widowed

Separated

Divorced / dissolved civil partnership

Other

Part 2: you and your household

Please tell us about yourself and all the people who are permanent members of your household (please refer to the guide to the housing register for a defnition) and are part of your application. Put your details in the frst line of the table.

Are any of these people pregnant? Yes No

Relationship Title Last name First Name Date of birth Sex Nationality

to you

Me / /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

If so, please tell us who is pregnant and when the baby is due

Date when baby is due / /

When the baby is born please provide a full copy of the birth certifcate. Your application will then be reviewed.

Part 3: marital status

Please use this section to tell us your marital status. Are you

Name Registered disabled?

Yes No Deaf or hard of hearing Mental health condition Wheelchair user Learning diffculties Problems getting around Any other disability (please specify)

Long-term illness Blind or partially sighted

Is the disability and /or medical condition made worse by your current housing? Yes No

Long-term illness Blind or partially sighted

Is the disability and /or medical condition made worse by your current housing? Yes No

Any other disability (please specify) Problems getting around Learning diffculties Wheelchair user Mental health condition Deaf or hard of hearing

Do you or any member of your household have a disability or health Yes No

condition that has lasted or is expected to last at least 12 months?

Are you a British Citizen returning from abroad? Yes No

Are you subject to immigration control? Yes No

Part 4: citizenship

We will ask you for an original passport and immigration papers for each person subject to UK immigration control. We will not accept photocopies.

Part 5: employment details and savings Please tell us about you and any second applicant’s employment details

Date Hours Gross earnings Employers name and

Job title employment worked before address

started each week deductions

/ / £ You

/ / £

Second / / £ applicant / / £

Do you or the second applicant have any savings? Yes No

You Second applicant If yes, please tell us how much £ £

Part 6: health and disabilities

If yes, please tell us who, whether they are registered as disabled and which of the following types of disability or illness they have.

Registered disabled?

Yes No

Name

If yes, you can ask for an assessment for extra priority for medical reasons. Please contact a lettings advisor on 01438 242666 when your application has been registered.

You Second applicant

When did you move into / /your present home?

What type of property do you live in?

House

Bungalow

Flat

Bedsit/studio fat

Maisonette

Mobile home or caravan

Hostel, guest house, hotel

Other (e.g. no fxed abode)

/ /

Please tick only one of the following. Are you

a council tenant?

a housing association tenant?

a private tenant?

living in accommodation tied to your employment?

sharing accommodation with others?

an owner-occupier?

in armed service accommodation?

a young person in the care of Herts County Council?

other (please give details)

Part 7: where you live now

Please tell us about your present home.

You Second applicant

If you are a council or housing association tenant, have you applied to buy your home

Yes No Yes No under the Right to Buy, preserved RTB, or Right to Acquire schemes?

Have you been asked to leave your present Yes No Yes No home within the next 28 days?

You Second applicant

Is your home self-contained? This means you do not have to share Yes No Yes No facilities with other households If your home is not self-contained, do you

Yes No Yes No share facilities with other households?

You Second applicant

Kitchen Yes Shared No Yes Shared No

Bath or shower Yes Shared No Yes Shared No

Toilet Yes Shared No Yes Shared No

You Second applicant

Landlord’s name Landlord’s name

Address with postcode Address with postcode

Landlord’s tel no Landlord’s tel no

Landlord’s email Landlord’s email

Part 7: where you live now (continued)

If you are a tenant, please give us the name, address and phone number of your landlord.

If yes, please contact the council’s Customer Service Centre by telephone on 01438 242666 or by textphone on 01438 242555

Part 8: your current housing situation

Please use this section to tell us about the property you live in now

Facilities – please tell us which of the following you have. If the facility is for your household only, tick yes. If you share them, tick shared. If you do not have them at all, tick no.

How many people live in the property? How many rooms are there in the property? Including people who will not be moving

Do not count bathrooms and kitchens in with you

YOU Which foor is

Room size How many What are the dates this room on? How are these

Double people of birth of the Basement, people related to

110.22 sq m sleep in people who sleep ground, frst you?

(110 sq ft) this room? in this room? and so on

Bedsit or studio fat

Double Bedroom one

Single

Double Bedroom two

Single

Double Bedroom three

Single

Double Bedroom four

Single

Double Bedroom fve

Single

Living room

Dining room

Other rooms, including bedroom in a hostel

Part 8: your current housing situation (continued)

Sleeping arrangements. Please tell us about the sleeping arrangements. You need to show which rooms are used by yourself and others. Tell us about the household of the second person applying on the next page if you live separately at the moment.

How many people live in the property? How many rooms are there in the property? Including people who will not be moving

Do not count bathrooms and kitchens in with you

SECOND APPLICANT (if living separately)

Which foor is Room size How many What are the dates

this room on? How are these Double people of birth of the

Basement, people related to 110.22 sq m sleep in people who sleep

ground, frst you? (110 sq ft) this room? in this room?

and so on

Bedsit or studio fat

Double Bedroom one

Single

Double Bedroom two

Single

Double Bedroom three

Single

Double Bedroom four

Single

Double Bedroom fve

Single

Living room

Dining room

Other rooms, including bedroom in a hostel

Part 8: your current housing situation (continued)

Only complete if second applicant is living separately at the moment. Sleeping arrangements. Please tell us about the sleeping arrangements of the household. You need to show which rooms are used by all the people included in your housing application.

What was the type and size of the last property you

occupied before moving into your current home? For example, 2 bedroom third foor fat.

If not listed on table in Part 10, have you ever held a tenancy at any other time with a council or housing association? Yes No

If yes, please give details

You When did When did Tenant, If you were a tenant, please

Address Why did you you move you move home- give the name and address

including postcode leave? in? out? owner etc of the landlord

Current home Month N/A N/A

Year

Month Month

Year Year

Month Month

Year Year

Month Month

Year Year

Month Month

Year Year

Month Month

Year Year

Month Month

Year Year

Month Month

Year Year

Month Month

Year Year

Address Dates Landlord

to from

/ / / /

/ / / /

Part 9: your previous homes

Please tell us about the other homes you have lived in for the last ten years (start with where you live now). On the next page, give us the details for the second applicant. If you need more space, please use another sheet of paper and sign and date it.

For each address, in the ‘How did you live there?’ column, please tell us whether you lived there as a council tenant, a housing association tenant, a private tenant, an owner occupier, on a shared ownership scheme, living with parents, living with other relatives, living with friends, as a lodger, living in a hostel, living in accommodation that came with your job and so on.

What was the type and size of the last property you

occupied before moving into your current home? For example, 2 bedroom third foor fat.

If not listed on table in Part 10, have you ever held a tenancy at any other time with a council or housing association? Yes No

If yes, please give details

Month Month

Year Year

Second applicant When did When did Tenant, If you were a tenant, please

Address Why did you you move you move home- give the name and address

including postcode leave? in? out? owner etc of the landlord

Current home Month N/A N/A

Year

Month Month

Year Year

Month Month

Year Year

Month Month

Year Year

Month Month

Year Year

Month Month

Year Year

Month Month

Year Year

Month Month

Year Year

Address Dates Landlord

to from

/ / / /

/ / / /

Part 9: your previous homes (continued)

Yes No Yes

You Second applicant

If yes, please give details No

Are you leaving services accommodation following You Second applicantthe death of a serving member of the armed forces (please refer to the guide to the housing register Yes No Yes No

Do you, the second applicant You Second applicant Household memberor household member currently

Yes No Yes No Yes No own a home?

Previous home owner

Have you or the second applicant You Second applicant Household member or household member ever owned

Yes No Yes No Yes Noany residential property in the past?

Did you buy the property under the Yes No Yes No‘Right to Buy’ scheme?

When did you sell the property? Date: / / Date: / /

Dates Rank Branch of service

From To

You / / / /

Second applicant / / / /

You Second applicant

Address of the property including postcode

Type of property, house, fat, bungalow, mobile home and so on

Part 10: armed forces Please use this section to tell us if you or the second applicant is currently serving or has served in the armed forces in the last 5 years.

for information)

Part 11: home ownership If you currently own a home you do not qualify to join the register Home ownership means any home you, the second applicant or any member of your household included in your application currently own. This includes property owned abroad, property owned under a shared-ownership scheme, sited mobile homes, houseboats, property owned jointly with any other person, property owned and rented out to another person.

Please tell us about any home you or the second applicant and any other member of your household have owned previously during the last ten years. This includes property owned abroad, property owned under a shared-ownership scheme, sited mobile homes, houseboats, property owned jointly with any other person, property owned and rented out to another person.

If yes, please tell us the following.

If you need more space please use another sheet of paper and sign and date it.

Do you or any member of your household have any unspent convictions or Yes Nohad any legal action taken against you for unacceptable behaviour / antisocial behaviour / crime? If yes, when was this and what was it for? Please list each incident separately and provide details on the outcome. If yes, please provide the information below

Name Offence Date of offence / conviction

Have you been evicted from a tenancy by a social landlord for breach of Yes No

tenancy conditions, including non-payment of rent, within the past fve years?

If yes, give details

Landlord Address Date

Have you any unspent criminal convictions within the last 5 years Yes No

If yes, please provide the information below

Where was Date of offence /

Name Offence the offence conviction

committed?

Part 12: behaviour

have unpaid right to buy discounts from any previous home?

If yes, please give details below

Yes Yes NoNo

Amount Address Landlord

have a tenancy deposit loan or rent in advance loan Yes No Yes Nothat you have not repaid?

If yes, please give details below

Amount Address Landlord

have outstanding council tax debts? Yes No Yes No

If yes, please give details below

Amount Address Landlord

have unpaid rent written off as part of a Yes No Yes Nobankruptcy proceeding?

If yes, please give details below

Amount Address Landlord

have unpaid sundry debts including rechargeable debts (such as court costs or for clearance, damage/repairs) with your current or former landlord?

If yes, please give details below

Yes Yes NoNo

Amount Address Landlord

Do you:

You Second applicant

have rent arrears or charges owed for use and occupation with your current or former landlord or local authority? If yes, please give details below

Yes Yes NoNo

Amount Address Landlord

Part 13: housing related debt

If you have a repayment arrangement relating to any of the debts, please provide a copy of the agreement and a statement of your payments with this form.

Family size and composition Number of bedrooms

Single person only Studio fat

Single person or couple with no dependant children as One bedroom

permanent members of the household

Family, one child Family, two children, same sex, both aged under 16 Family, two children, different sexes, both aged ten or under

Two bedroom Couple with medical recommendation for separate bedrooms Single person or couple with verifed need for permanent, full-time, live-in carer

Family, two children Family, three children Three bedroom Family, four children

Family with four children Large three bedroom (three doubles)

Family three children, where none can share a bedroom Four bedrooms Family four children (two doubles and two singles)

Four bedroom Family fve or more children

(three doubles and one single)

Family fve or more children Five bedroom - any combination

Do you want to be considered for sheltered housing (people over 60 only)? Yes No

Would you like to be considered for low cost ownership? Yes No

Part 14: accommodation needed

The table below shows the types of property we would normally offer you.

This does not commit you to anything.

For further details visit our website www.stevenage.gov.uk

Muslim

Sikh

No religious belief

Prefer not to say

Other

Please tell us your sexual orientation

Heterosexual (straight)

Homosexual/Gay

Bisexual

Prefer not to say

Jewish

Asian or Asian British (Indian/Pakistani/Bangladeshi/Chinese/Other)

Black or Black British (African/Caribbean/Other)

Mixed

Other ethnic group

White - British/English/Northern Irish/ Scottish/Welsh

White - European

White - Gypsy or Irish Traveller

White - Irish

White - Other

Prefer not to say

Please tell us your Religion/Belief

Buddhist

Christian

Hindu

Part 15: equalities and diversity information

You Second applicant Please tell us your Race/ethnic background

Ethnic background means the ethnic group of your ancestors. It is not the same as your nationality.

Large print

Audio or visual translation

Braille

Is sign language your main way of communicating?

If yes, which type of sign language do you use?

British Sign Language

Makaton

Other (please give details)

What is your frst language?

You Second applicant

Yes No Yes No

Yes No Yes No

Yes No Yes No

Yes No Yes No

Access to information Would you fnd it useful to receive information in any of the following formats? Tick as many as you need to.

Part 16: extra information

Please use this section to tell us if there is any other information about your housing application that you would like us to know.

please tick

Two proofs of identity for you and the second applicant, two proofs of identity for each person on the application over 16, and one proof for all others

Proofs of address for each year in the last fve years out of the past seven for each applicant, the last year within six months

Two proofs of address for each person on the application over 16 years of age

Passport and immigration papers if needed

Employment contract for non-British Citizen of EU member

Key worker contract details

Former homeowners - provide proof of sale and completion statement

Other proof we ask for. See ‘proof of circumstances - A Brief Guide’

Part 17: checklist

Please use this checklist to make sure that you have given us all the proofs of identity and address that we need. We need proof of identity for everyone included in your application, including children, and proof of address for everyone aged over 16. We may need other proofs, depending on your circumstances. See ‘proof of circumstances - A Brief Guide’.

To process your application we need you to provide all of the required proofs. If you haven’t provided everything we will write and ask you for the additional information, while we are waiting for this we will keep your application and documents safe for 56 days. If we do not hear from you within 56 days your application and documents will be disposed of safely and you will be required to start your application to join the Housing register again. If you need to speak to us about this you can email centraladminteam@stevenage.gov.uk or call us on 01438 242666.

We only accept original documents.

Part 18: right to request a review

Under the terms of the Housing Act 1996 as amended by the Localism Act 2011, applicants have a right to information about certain decisions that are taken in respect of their applications and the right to request a review of those decisions.

The council must notify applicants in writing of a decision that they are not eligible to join the housing register or do not qualify to join the housing register. This notifcation must give clear grounds for the decision, which will be frmly based on the relevant facts of the case, and must also advise the applicant of their right to request a review of the decision.

Applicants may also request a review of any decision made in connection with their application. This could include:

• assessment of their banding• reasonableness of a direct allocation• cancellation of an application

You must ask for a review in writing within 21 days of receiving our decision, stating clearly why you think our decision is wrong.

Part 19: important information

Stevenage Borough Council and our partner housing associations are committed to creating stable and secure communities. In order to support these aims we or our partners may carry out checks, including credit reference checks and ask for references.

We may need to approach other agencies and individuals to provide or verify information needed to support your housing application and will require you to authorise such agencies and individuals to disclose information to us.

In order to verify information you have provided we may approach data referencing agencies, use information that is in the public domain or use data-matching exercises on data already held by Stevenage Borough Council.

Under the Prevention of Housing Fraud Act 2013 and associated regulations Stevenage Borough Council can require third parties to share information with us in order to prevent or detect housing fraud crimes.

Housing fraud, false statement, withholding information and failing to update relevant changes in circumstances

Important notice under the Housing Act 1996 s.171 & s.214 Where a person approaches Stevenage Borough Council seeking the allocation of housing or claiming to be homeless or threatened with homelessness, the above Act makes it an offence punishable with a fne, for a person to make a false statement or to withhold relevant information. For homeless applicants it is also an offence to fail to inform the housing authority of any material changes in circumstance after making an application.

If we discover that you have made a fraudulent application we may cancel, put on hold, demote or amend your application for housing. If a person fraudulently gains a council or housing association tenancy we have a policy of pursuing prosecutions. We will also take legal action to regain possession of your home. We may also seek redress under the Proceeds of Crime Act 2002.

Relationship Name Address Signature Date

to applicant

/ /

You Second applicant

Signature

Date / / / /

Part 20: declaration

These declarations must be signed by the main applicant and second applicant (if applicable)

1. I/we understand that it is an offence to• give false information• withhold relevant informationand that Stevenage Borough Council may• cancel, put on hold, demote or amend any application I have made whilst it investigates and

takes action• prosecute me and I may be liable for a monetary fne• evict me from accommodation obtained by fraud• seek compensation from my proceeds of housing fraud.

2. I understand the Council will use my information to assess my housing application and mayshare my information with other Housing Associations and Councils to assess my housingneeds and medical conditions as is necessary for the Council to perform its public tasks. Iunderstand the Council may also obtain information held by third parties and that I may becharged by such parties for providing the information and that the Council will not acceptliability for such charges.

I understand that Stevenage Borough Council may share my information for preventing and detecting crime including housing fraud.

3. I/we authorise Stevenage Borough Council to make enquiries and obtain information fromthird party agencies and individuals in relation to my application for Housing from StevenageBorough Council

If you are flling in this form on behalf of someone else, please tell us your name and address and relationship to the applicant, and then sign and date the form below.

We strongly advise you to bring your completed form together with all the proof we ask for to the Customer Service Centre at Daneshill House, where we will photocopy your proofs and return them to you straightaway. If you cannot bring your form and proof to us in person, you can post them to us at the address below. We are not responsible for your original documents.

Lettings Team Stevenage Borough Council Please make sure that you get a receipt for all Daneshill House your documents and that you keep it in a safe Danestrete place in case you need it in the future. Stevenage Hertfordshire SG1 1HN

For offce use only Verifcation checks at application date Yes No Action/comment

Form fully completed If no, return to applicant

Form signed If no, return to applicant

Proof of identity x 2 If no, return to applicant

Proof of address for the last fve years for each applicant If no, return to applicant

Returned form to applicant If yes, when?

Local Connection

Lived 5 years out of the past 7 in Stevenage (includes temporary time away studying)

Lived 5 years out of the last 7 in Stevenage but temporarily living outside Stevenage (respite, supported housing custodial sentence, bail conditions)

Employed in Stevenage in a keyworker role for 24 hours a week or more continuously for the past 5 years out of the past 7

Serving in the Armed Forces

Placed under the care of HCC within Stevenage continuously for the past 5 years

Lived in a Stevenage Woman’s aid refuge for 6 months

Eligibility and Qualifcation

Eligible to housing (Part 4)

Currently owns a home

Previously owned a property

Employment history provided

Behaviour - ASB

Behaviour - conviction

Behaviour – eviction

Housing related debts

Checks

On Northgate

Cancelled application in archives

Debts former / current

Credit reference checks

Transfer

Size of property

Bedroom need

Property reference

Balance on rent account

Any other housing related debts

Right to Buy

Additional Notes