Application for Housing 1About you2Who else is moving?3Pregnancy4Eligibility5Pets6Previous addresses7Where do you stay now?8Homelessness9Why are you applying for housing?10Condition of your current housing11Personal housing needs12Areas of choice13Housing you want14Additional information15Checklist16Monitoring17Declaration Before you start filling in this form, make sure you have the following information to hand, if it is relevant: Proof of Power of Attorney if someone is acting on your behalf Proof that you are eligible to claim for housing if you are not a British citizen Proof of your current address. This could be a bill or bank statement. Proof of the council’s decision to assess you as homeless Evidence that you have been asked to leave your current accommodation. Confirmation of HM Forces discharge date Proof of poor living conditions, including photos Please complete this form in as much detail as possible. We have included some Frequently Asked Questions and a short guide to filling in this form. Please give these a read through before you start filling in your application. If you need a hand to fill it in please get in touch and one of our team will be delighted to help you. If you have a medical need that you would like us to consider as part of your application, you should also fill in the Medical Assessment Form. Please complete a Medical Assessment Form if you need us to consider: an illness or disability your support needs what you need to help you live independently or your need for a special type of housing (for example, sheltered housing) If there is more than one person applying for housing because of their health needs, each of them should fill in a separate medical assessment form. We will process your application form within seven days after we receive it. We may contact you if we need further information. You can read our Lettings Policy here.Sections 1 – 5: About you and who else will be moving with you Complete these sections in full. Remember to include all persons who currently live with you, their dates of birth and relationship to you. If anyone on your application has a medical condition that will affect your need for housing, please complete the medical assessment at the back of this form.1. About youTitleName* First Last I identify my gender as: Man Woman Non-binary Current address* Address Line 1 Address Line 2 Town/City County Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Is your home rented? Yes No Name of landlord or letting agentAddress of your landlord or letting agent Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Phone number of your landlord or letting agentEmail address of your landlord or letting agent Upload proof of current addressMax. file size: 128 MB.Date of birth* DD slash MM slash YYYY National Insurance no.*Home phoneMobile numberEmail address*Please check that you have typed your email address correctly, otherwise we may have difficulty getting back to you. Enter Email Confirm Email Are you registered disabled? Yes No Do you need to fill in a Medical Assessment Form? Yes No Are you applying jointly with another applicant?*A "Joint Applicant" is another adult with whom you will have a joint tenancy Yes No Joint ApplicantTitleName* First Last I identify my gender as: Man Woman Non-binary Relationship to the first applicantDoe the Joint Applicant currently live at the same address as the first applicant? Yes No Current address Address Line 1 Address Line 2 Town/City County Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Date of birth* DD slash MM slash YYYY National Insurance no.Home phoneMobile numberEmail address*Please check that you have typed your email address correctly, otherwise we may have difficulty getting back to you. Enter Email Confirm Email Are you registered disabled? Yes No Do you need to fill in a Medical Assessment Form? Yes No Additional addressIf you want your post sent to a different address or someone else to act on your behalf, please provide details belowDo you want? Your post sent to a different address? Someone else to act on your behalf? Does this person have Power of Attorney? Yes No Please provide proof of Power of AttorneyYou can upload documents hereMax. file size: 128 MB.Additional address detailsTitleName* First Last Address* Address line 1 Address Line 2 Town/City County Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Relationship to youPhoneEmail Sections 1 – 5: About you and who else will be moving with you Complete these sections in full. Remember to include all persons who currently live with you, their dates of birth and relationship to you. If anyone on your application has a medical condition that will affect your need for housing, please complete the medical assessment at the back of this form.2. Who else will be moving with you?Please give details of who else will be moving with you (apart from a Joint Applicant listed in Section 1). This includes everyone who lives with you now and and those who don’t live with you but will be moving with you.Is anyone else moving with you, other than the main and/or joint applicant?* Yes No Person 1TitleName First Last They identify their gender as: Man Woman Non-binary Date of birth DD slash MM slash YYYY NI NumberRelationship to you?Are they registered disabled? Yes No Do they live with you now? Yes No Please give their addressAdd another person? Yes No Person 2TitleName First Last They identify their gender as: Man Woman Non-binary Date of birth DD slash MM slash YYYY NI NumberRelationship to you?Are they registered disabled? Yes No Do they live with you now? Yes No Please give their addressAdd another person? Yes No Person 3TitleName First Last They identify their gender as: Man Woman Non-binary Date of birth DD slash MM slash YYYY NI NumberRelationship to you?Are they registered disabled? Yes No Do they live with you now? Yes No Please give their addressAdd another person? Yes No Person 4TitleName First Last They identify their gender as: Man Woman Non-binary Date of birth DD slash MM slash YYYY NI NumberRelationship to you?Are they registered disabled? Yes No Do they live with you now? Yes No Please give their addressAdd another person? Yes No Person 5TitleName First Last They identify their gender as: Man Woman Non-binary Date of birth DD slash MM slash YYYY NI NumberRelationship to you?Are they registered disabled? Yes No Do they live with you now? Yes No Please give their addressAdd another person? Yes No Person 6TitleName First Last They identify their gender as: Man Woman Non-binary Date of birth DD slash MM slash YYYY NI NumberRelationship to you?Are they registered disabled? Yes No Do they live with you now? Yes No Please give their addressThis field is hidden when viewing the formIf any of these people don't live with you now, please explain Sections 1 – 5: About you and who else will be moving with you Complete these sections in full. Remember to include all persons who currently live with you, their dates of birth and relationship to you. If anyone on your application has a medical condition that will affect your need for housing, please complete the medical assessment at the back of this form.3. PregnancyAre you, or is anyone who is moving with you pregnant? Yes No Name of person who is pregnantUse the button to add more people Proof of pregnancyIf you, or anyone on your application is pregnant, you must provide proof. Drop files here or Select files Max. file size: 128 MB. Sections 1 – 5: About you and who else will be moving with you Complete these sections in full. Remember to include all persons who currently live with you, their dates of birth and relationship to you. If anyone on your application has a medical condition that will affect your need for housing, please complete the medical assessment at the back of this form.4. EligibilityIf you have come to live in the UK from abroad, under the Housing (Scotland) Act 2001 and the Asylum and Immigration Act 1999, we must find out if you qualify for public help, including housing.Are you and all members of your household British citizens?* Yes No List the people who are not British citizens*NameNationality Upload proof that they are eligible to claim for housingMax. file size: 128 MB. Sections 1 – 5: About you and who else will be moving with you Complete these sections in full. Remember to include all persons who currently live with you, their dates of birth and relationship to you. If anyone on your application has a medical condition that will affect your need for housing, please complete the medical assessment at the back of this form.5. PetsCats and dogs are not allowed in some of our properties. Please contact us for more information on this.Do you or any of your household have pets? Yes No What type of pets? Section 6: Previous addresses Please list all your previous addresses in the last three years, starting with your present address. You should provide the full name and address of your current/previous landlord or mortgage provider, with dates and reasons for leaving.6. Previous addressesHow long have you lived at your current address?Years*Please enter a number greater than or equal to 0.Months*Please enter a number from 0 to 12.If you have lived here for less than three years, please tell every address you have lived at during the last three years. Do not include your current address.Previous address 1 Address Line 1 Address Line 2 Town/City County Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country From (month)monthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberFrom (year)To (month)monthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberTo (year)Owned by (give their name and address)Reason for leavingAdd another address? Yes No Previous address 2 Address Line 1 Address Line 2 Town/City County Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country From (month)monthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberFrom (year)To (month)monthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberTo (year)Owned by (give their name and address)Reason for leavingAdd another address? Yes No Previous address 3 Address Line 1 Address Line 2 Town/City County Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country From (month)monthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberFrom (year)To (month)monthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberTo (year)Owned by (give their name and address)Reason for leavingAdd another address? Yes No Previous address 4 Address Line 1 Address Line 2 Town/City County Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country From (month)monthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberFrom (year)To (month)monthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberTo (year)Owned by (give their name and address)Reason for leaving Section 7 and 8: Where do you live now and homelessness Tell us where you live now. We have a statutory duty to re-house people who are assessed by a local authority as homeless and will not refuse housing unless we have good reason to. Please provide proof of homelessness such as a Notice to Quit.7. Where do you stay now?First ApplicantThis field is hidden when viewing the formSection BreakWhere do you stay now?* A Cairn property I am a council tenant I am a tenant of another housing association I own a shared ownership property I am a home owner I privately rent A property that comes with my job Prison Parents or Relatives Friends A hostel Council temporary accomodation Hospital Residential care/supported housing Bed & Breakfast Caravan/mobile home Sleeping rough Which council?Which housing association?Joint ApplicantWhere do you stay now? (Joint Applicant)* A Cairn property I am a council tenant I am a tenant of another housing association I own a shared ownership property I am a home owner I privately rent A property that comes with my job Prison Parents/Relatives/Friends A hostel Council temporary accomodation Hospital Residential care/supported housing Bed & Breakfast Caravan/mobile home Sleeping rough Which council?Which housing association? Section 7 and 8: Where do you live now and homelessness Tell us where you live now. We have a statutory duty to re-house people who are assessed by a local authority as homeless and will not refuse housing unless we have good reason to. Please provide proof of homelessness such as a Notice to Quit.8. HomelessnessFirst ApplicantThis field is hidden when viewing the formSection BreakIf you are an owner, do you have to sell your home?* Yes No If yes, please state the reason for sale:Are you homeless OR threatened with homelessness?* Yes No If yes, please give details*Have you been assessed by the Council as homeless or at risk of becoming homeless?* Yes No If yes, please give the name of the Council office you applied toDate of your application MM slash DD slash YYYY Outcome of applicationHave you been told to leave your current accomodation?* Yes No If yes, plase give date for leavingReason for leavingSupporting documentsPlease provide relevant evidence. For example, a copy of your Notice to Quit, Court Order or a copy of your homeless assessment. If you have been asked to leave the home of your friend or family, please provide a letter confirming this. Drop files here or Select files Max. file size: 128 MB. Joint ApplicantIf you are an owner, do you have to sell your home?* Yes No If yes, please state the reason for sale:Are you homeless OR threatened with homelessness?* Yes No If yes, please give detailsHave you been assessed by the Council as homeless or at risk of becoming homeless?* Yes No If yes, please give the name of the Council office you applied toDate of your application MM slash DD slash YYYY Outcome of applicationHave you been told to leave your current accomodation?* Yes No If yes, plase give date for leavingReason for leavingSupporting documentsPlease provide relevant evidence. For example, a copy of your Notice to Quit, Court Order or a copy of your homeless assessment. Drop files here or Select files Max. file size: 128 MB. Section 9: Why you are applying for housing Please tell us the reason why you are applying for housing. If you are leaving HM Forces, please remember to provide proof.9. Why are you applying for housing?First ApplicantThis field is hidden when viewing the formSection BreakPlease tick the main reason I have to leave my current accommodation I have had a relationship breakdown My current house is unsuitable due to medical conditions I need a smaller house I need a bigger house I’m currently staying with friends/family and want my own home I am a young person leaving care I want to move closer to a relative to give/receive support I am leaving HM Forces I need to move closer to work I am leaving supported accommodation I am leaving a long term stay in hospital I am in financial difficulty I am leaving prison I have no permanent or secure accommodation I want to move to another area I want to move to sheltered/retirement housing My current accommodation lacks amenities If you are leaving HM Forces, what is your discharge date? DD slash MM slash YYYY Please provide proofMax. file size: 128 MB.Joint ApplicantPlease tick the main reason I have to leave my current accommodation I have had a relationship breakdown My current house is unsuitable due to medical conditions I need a smaller house I need a bigger house I’m currently staying with friends/family and want my own home I am a young person leaving care I want to move closer to a relative to give/receive support I am leaving HM Forces I need to move closer to work I am leaving supported accommodation I am leaving a long term stay in hospital I am in financial difficulty I am leaving prison I have no permanent or secure accommodation I want to move to another area I want to move to sheltered/retirement housing My current accommodation lacks amenities If you are leaving HM Forces, what is your discharge date? DD slash MM slash YYYY Please provide proofMax. file size: 128 MB. Section 10: Condition of current housing Please fill this section in so we know whether you are overcrowded or under occupying. We also need to know the type of heating you currently have and if your home is in need of major repair or is unsafe. Please provide photos if you can.10. Condition of your current housingConditionIs your home in need of major repair?*For example, it’s not wind or water tight, or it’s unsafe. Yes No Is your home in a poor state of general maintenance?*For example, poor internal fittings, joinery or plasterwork. Yes No Facilities Do you have the following in your current property?Kitchen or cooking facilities* Yes No Bathing facilities* Yes No Inside toilet* Yes No Sink with hot and cold running water* Yes No Central heating* Full Partial None Has Environmental Services or any other organisation tested your:water and found it unsafe?* Yes No drainage and found it inadequate?* Yes No property and found rising or penetrative damp?* Yes No Please provide proof of poor housing conditions, including photos if possible Drop files here or Select files Max. file size: 128 MB. Overcrowding and under-occupation How many bedrooms does the property you stay at have?Double bedrooms*Single bedrooms*Do you share any of the following rooms with another household (other than your parents or children)?* Living room Kitchen Bathroom None of these Is any member of your household forced to live apart from you due to overcrowding in your current home?* Yes No If yes, tell us who this is Section 11: Personal housing needs Let us know if you are experiencing physical, emotional or sexual abuse, or any kind of antisocial behaviour. Tell us of any caring arrangements you have in place. Please provide evidence where you can.11. Your personal housing needsDomestic abuseAre you at risk of physical, mental or sexual abuse from someone in your household?* Yes No If yes, please give detailsIf you answered yes to the above question, you must provide confirmation of this from the Police or another official source, such as a Solicitor or a Social Worker.HarassementAre you suffering from harassment, violence or other antisocial behaviour from outwith your household?* Yes No If yes, please give detailsIf you answered yes to the above question, you must provide confirmation of this from the Police or another official source, such as a Solicitor or a Social Worker.SupportDo you need to give support to someone?* Yes No Do you need to get support from someone?* Yes No Relationship to the applicant?This field is hidden when viewing the formSupport detailsPlease give the person's name and address belowTitleName First name Last name Address Address Line 1 Address Line 2 Town/City County Postcode Phone numberWhy do you need to move to give/get support?What support is needed and how often?Going outside Every day Other give detailsShopping Every day Other give detailsCleaning Every day Other give detailsGoing to bed and/or getting up Every day Other give detailsMoney and benefits Every day Other give detailsCooking Every day Other give detailsPersonal care Every day Other give detailsChildcare Every day Other give detailsOther support Every day Other give detailsPlease give details of what other support is neededDoes the person who will receive support get benefits for support to be given?For example, DLA or PIP. Yes No Care arrangementsDo you need another room for respite care, foster care or overnight access for children?* Yes No Please add details of children requiring care*Do not include anyone from section 2NameDate of BirthWho they live withAddressPostcodeType of care (respite/foster/access)Nights per week Section 12 and 13: Areas of choice and housing you want Tell us where you’d like to move to and what kind of housing you’d prefer. Not all of our housing is let by us – you may have to fill in a Common Housing Register form to apply for housing in some areas.12. Areas of choiceWhat types of housing would you like?* General housing (house, flat) - suitable for age 16+ Accessible housing and wheelchair access - suitable for age 16+ Accessible housing and wheelchair access - suitable for age 50+ Flat in a community setting - suitable for age 50+ Sheltered housing - suitable for age 60+ General Housing (age 16+)*Please tick the areas you would like to live below Arbroath Dumbarton Dundee East Whitburn Elgin Falkirk Forres Kelty Kirkintilloch Lambhill, Glasgow Longridge Newcastleton Perth Pollock, Glasgow Pumpherston Stirling Tillicoultry Accessible housing and wheelchair access (age 16+)*Please tick the areas you would like to live below Coatbridge Dumbarton Kirkcaldy Accessible housing and wheelchair access (age 50+)*Please tick the areas you would like to live below Burntisland Cowdenbeath Flat in a community setting (age 50+)*Please tick the areas you would like to live below Bathgate Broughty Ferry Campbeltown Carnoustie Eyemouth Glenrothes Hawick Kirckcaldy Paisley Peterhead Rosyth Stenhousemuir Stirling St Abbs Sheltered housing (age 60+)*Please tick the areas you would like to live below Blairgowrie Galashiels Perth Rutherglen Sanquhar Common Housing RegistersIn other areas we are part of a common housing register. This means you just have to fill in one form for affordable housing in your local authority area. We’re part of Common Housing Registers in: Edinburgh (EdIndex) Fife (Fife Housing Register) Highland (Highland Housing Register) North Lanarkshire Council South Lanarkshire (HomeFinder) Homes available nowSome of our homes are available to rent and move into right now. Here is an up-to-date list of the homes we have available just now. Section 12 and 13: Areas of choice and housing you want Tell us where you’d like to move to and what kind of housing you’d prefer. Not all of our housing is let by us – you may have to fill in a Common Housing Register form to apply for housing in some areas.13. Housing you wantWhat size of property would you accept?You may be ineligible for some property sizes as stated in our Lettings Policy. A high number of our sheltered or retirement housing consists of one-person flats. This is a flat which has a separate bathroom and kitchen with a living room and bedroom combined. 1 person flat (studio) 1 bedroom 2 bedrooms 3 bedrooms 4+ bedrooms Does this include an extra bedroom? No Yes, for health reasons Yes, for support Yes, for child access If you need an extra bedroom, please give detailsDo you have a need for: Ground floor accomodation only? Wheelchair acessible housing? Other specialist adaptations? If there is a reason why you are applying for housing which you feel has not been covered fully in this application form, please give details Section 14: Additional information You must tell us if you or an applicant is a registered sex offender as the application will be subject to our Re-housing of Sex Offenders Policy. You must also tell us if someone has taken court action against you for antisocial behaviour.14. Additional informationAntisocial behaviour*Has anyone ever taken court action against you, or anyone moving with you, for antisocial behaviour? Yes No Sex Offenders Act*Do you, or anyone moving with you, have to register with the police under the Sex Offenders Act 1997 or Sexual Offences Act 2003? Yes No Section 15: Checklist Please go through the checklist to make sure you are sending us all necessary evidence and information.15. ChecklistYou should have added proof of certain information as you have gone through this form. If there is anything you haven’t added yet, or anything you think is relevant for us to know (for example, proof of poor living conditions) then please add it here.UploadMax. file size: 128 MB.List all the people you will be completing a Medical Assessment Form forIf you, or anyone in your household, is registered disabled or has a medical condition that affects your need for housing, please complete a Medical Assessment Form for each person. Remember to include yourself if appropriate.First nameLast name Section 16: Monitoring You don’t need to complete this section if you don’t want to. It will in no way affect your application with us. We ask for this information to make sure that no discrimination takes place.16. MonitoringThe following questions are for monitoring purposes only and will not be used when assessing your application.First ApplicantThis field is hidden when viewing the formSection BreakHow would you describe your ethnic group?White Scottish English Welsh Northern Irish British Irish Gypsy/Traveller Polish Other white background please specifyplease specifyAsian, Asian Scottish or Asian British Pakistani Indian Bangladeshi Chinese Other Asian background please specifyplease specifyBlack, Black Scottish or Black British African Caribbean Other Black background please specifyplease specifyMixed BackgroundAny mixed background (please specify)Other Ethnic Background Arab, Arab Scottish or Arab British Other ethnic background please specifyplease specifyDisabilityDo you consider yourself to have a disability?By disability we mean a condition which has a long term and substantial effect on your ability to carry out day to day activities. Yes No Joint ApplicantHow would you describe your ethnic group?White Scottish English Welsh Northern Irish British Irish Gypsy/Traveller Polish Other white background please specifyplease specifyAsian, Asian Scottish or Asian British Pakistani Indian Bangladeshi Chinese Other Asian background please specifyplease specifyBlack, Black Scottish or Black British African Caribbean Other Black background please specifyplease specifyMixed BackgroundAny mixed background (please specify)Other Ethnic Background Arab, Arab Scottish or Arab British Other ethnic background please specifyplease specifyDisabilityDo you consider yourself to have a disability?By disability we mean a condition which has a long term and substantial effect on your ability to carry out day to day activities. Yes No 17 Privacy & DeclarationSection 17: Declaration Please make sure you and the joint applicant (if applicable) sign the form.General Data Protection Regulation 2018 (GDPR)The information that you have given in this application form will be used by Cairn Housing Association to process your application for housing. Details of how we handle personal data can be found in our Privacy Notice, available on our website or on request. The Privacy Notice details what information we may collect from you, how we use your information and the rights you have.DeclarationPlease read through the following statements and sign at the bottom to show you understand and agree with them.Signature of applicant* All of the answers given by me are correct. If I supply any false information or keep back any information my application may be cancelled. That if I am given a tenancy because I have supplied false information or I have kept back information, the tenancy may be ended. That my current or previous landlord(s) can be contacted for a reference. My doctor, hospital consultant, health visitor, social worker, police or any other relevant person can be contacted if more information is needed for my housing application. I have read the data protection statement in Section 18 above. I will inform Cairn of any changes in my/our circumstances. I understand that completion of this application form does not guarantee an offer of housing. Date* DD slash MM slash YYYY Signature of joint applicant* All of the answers given by me are correct. If I supply any false information or keep back any information my application may be cancelled. That if I am given a tenancy because I have supplied false information or I have kept back information, the tenancy may be ended. That my current or previous landlord(s) can be contacted for a reference. My doctor, hospital consultant, health visitor, social worker, police or any other relevant person can be contacted if more information is needed for my housing application. I have read the data protection statement in Section 18 above. I will inform Cairn of any changes in my/our circumstances. I understand that completion of this application form does not guarantee an offer of housing. Date* DD slash MM slash YYYY application-refEmailThis field is for validation purposes and should be left unchanged. Δ