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Tel: 01782 844541
Application Form
Property Address
*
Section 1: Your details
NAME & CONTACTS
Type of Application
*
Single
Joint
Name
*
Title (Mr, Mrs, Ms, Dr etc)
First name
Surname or family name
You
Previous name/s (if applicable)
Title (Mr, Mrs, Ms, Dr etc)
First name
Surname or family name
You
Your relationship to joint applicant
Wife
Husband
Partner
Son
Daughter
Father
Mother
Aunt
Uncle
Cousin
In law
No relation
Name
*
Title (Mr, Mrs, Ms, Dr etc)
First name
Surname or family name
Joint Applicant
Previous name/s (if applicable)
Title (Mr, Mrs, Ms, Dr etc)
First name
Surname or family name
Joint Applicant
Daytime telephone
*
You
Mobile telephone
You
Work telephone
You
Daytime telephone
*
Joint Applicant
Mobile telephone
Joint Applicant
Work telephone
Joint Applicant
Email
You
Email
Joint Applicant
Present address
*
Address Line 1
Address Line 2
Address Line 3
Address Line 4
Postcode
Time living at current address
*
Less than a year
1 year
2 years
3 years
4 years
5 or more years
Please select which of the following best describes your current housing situation
*
Council tenant
Housing association tenant
Private tenant
Owner occupier
Living with family / friends
You
Present Landlord
*
Please provide the
name, address and telephone number
of your current landlord, agent or housing association. We will contact them for a reference.
Please tick here if the joint applicant has a different address
Present address of joint applicant
*
Address Line 1
Address Line 2
Address Line 3
Address Line 4
Postcode
Joint Applicant
Joint applicant's time living at current address
*
Less than a year
1 year
2 years
3 years
4 years
5 or more years
Please select which of the following best describes the joint applicant's current housing situation
*
Council tenant
Housing association tenant
Private tenant
Owner occupier
Living with family / friends
Joint Applicant
Present Landlord of the joint applicant
*
Please provide the
name, address and telephone number
of the joint applicant's current landlord, agent or housing association. We will contact them for a reference.
May we contact your present landlord/s for references?
*
Yes
No
Not applicable
Present Rent
Rent interval
Weekly
Monthly
Not applicable
Section 1: continued
PERSONAL DETAILS
Date of Birth
*
You
Gender
*
You
National Insurance number
*
You
Date of Birth
*
Joint Applicant
Gender
*
Joint Applicant
National Insurance number
*
Joint Applicant
Section 2: People who will live with you
OTHER PEOPLE
Please select how many people (including children) will live you (excluding joint applicant if applicable)
*
0
1
2
3
4
Person 1: Name
*
Relationship
*
Wife
Husband
Partner
Son
Daughter
Father
Mother
Aunt
Uncle
Cousin
In law
No relation
Date of Birth
*
Employment status
*
Person 2: Name
*
Relationship
*
Wife
Husband
Partner
Son
Daughter
Father
Mother
Aunt
Uncle
Cousin
In law
No relation
Date of Birth
*
Employment status
*
Person 3: Name
*
Relationship
*
Wife
Husband
Partner
Son
Daughter
Father
Mother
Aunt
Uncle
Cousin
In law
No relation
Date of Birth
*
Employment status
*
Person 4: Name
*
Relationship
*
Wife
Husband
Partner
Son
Daughter
Father
Mother
Aunt
Uncle
Cousin
In law
No relation
Date of Birth
*
Employment status
*
Do you have any pets?
*
Yes
No
Number and type of pet(s)
*
Section 3: Your previous addresses
How many previous addresses have you had in the last 5 years?
*
0
1
2
3 or more
Previous address no. 1
*
Address Line 1
Address Line 2
Address Line 3
Address Line 4
Postcode
Date moved in
*
Date moved out
*
Please select which of the following best describes your housing situation at this address
*
Council tenant
Housing association tenant
Private tenant
Owner occupier
Living with family / friends
Reason for moving
*
Landlord at previous address no.1
*
Please provide the
name, address and telephone number
of the landlord, agent or housing association.
Previous address no. 2
*
Address Line 1
Address Line 2
Address Line 3
Address Line 4
Postcode
Date moved in
*
Date moved out
*
Please select which of the following best describes your housing situation at this address
*
Council tenant
Housing association tenant
Private tenant
Owner occupier
Living with family / friends
Reason for moving
*
Landlord at previous address no.2
*
Please provide the
name, address and telephone number
of the landlord, agent or housing association.
Please list any further previous addresses here
*
Please include the
name, address and telephone number
of the relevant landlord, agent or housing association with each address
How many previous addresses has the joint applicant had in the last 5 years?
*
0
1
2
3 or more
Previous address no. 1
*
Address Line 1
Address Line 2
Address Line 3
Address Line 4
Postcode
Joint Applicant
Date moved in
*
Date moved out
*
Please select which of the following best describes the joint applicant's housing situation at this address
*
Council tenant
Housing association tenant
Private tenant
Owner occupier
Living with family / friends
Reason for moving
Landlord at previous address no.1
*
Joint Applicant
Please provide the
name, address and telephone number
of the landlord, agent or housing association.
Previous address no. 2
*
Address Line 1
Address Line 2
Address Line 3
Address Line 4
Postcode
Joint Applicant
Date moved in
*
Date moved out
*
Please select which of the following best describes the joint applicant's housing situation at this address
*
Council tenant
Housing association tenant
Private tenant
Owner occupier
Living with family / friends
Reason for moving
Landlord at previous address no.2
*
Joint Applicant
Please provide the
name, address and telephone number
of the landlord, agent or housing association.
Please list any further previous addresses here
*
Please include the
name, address and telephone number
of the relevant landlord, agent or housing association with each address
Section 4: Employment and income
Do you have a bank account?
*
Yes
No
Please be aware that we cannot offer you a home without a bank account.
Occupation
*
Employer's name, address and telephone number
*
May we contact your employer for references?
*
Yes
No
Not applicable
Please state your annual income here
*
Occupation
*
Joint Applicant
Employer's name, address and telephone number
*
Joint Applicant
May we contact the joint applicant's employer for references?
*
Yes
No
Not applicable
Please state the joint applicant's annual income here
*
Section 5: Benefits
BENEFIT DETAILS: Please state the amount you receive for each benefit listed below
Is your household entitled to Housing Benefit?
*
Full
Part
No
Don't Know
You: the main applicant
Jobseekers' Allowance
Income Support
Child Benefit
State Pension
Pension Credit
Working Tax Credit
Carer's Allowance
ESA
DLA Care
please select DLA Care level
Low
Middle
High
DLA Mobility
please select DLA Mobility level
Low
Middle
High
Please state the amount received for each benefit listed below for the
joint applicant
Jobseekers' Allowance
Income Support
Child Benefit
State Pension
Pension Credit
Working Tax Credit
Carer's Allowance
ESA
DLA Care
please select DLA Care level
Low
Middle
High
DLA Mobility
please select DLA Mobility level
Low
Middle
High
Other (please state name of benefit & value):
Other (please state name of benefit & value):
Section 6: Why you want to move
Please tell us why you want to move.
*
Tell us if you are homeless or about to be made homeless. Also state any medical or job-related reasons for moving and anything else you feel is important. If you are moving to Staffordshire from another area, please give names and addresses of relatives you want to move near to if applicable.
Please tell us which area you would prefer to live in.
Blurton
Cobridge
Fenton
Hanley
Longton
Meir
Northwood
Oakhill
Shelton
Sneyd Green
Stoke
Trent Vale
Trentham
Section 7: Our lettings policy
We aim to create sustainable tenancies and stable communities. Because of this, we have an exclusion policy which enables us to exclude households from our register if:
proven evidence exists that they have a history of significant non-payment of rent or significant housing debt with any local authority or housing association;
they have a history of nuisance, violence or anti-social behaviour; or
they have been convicted of certain criminal offences
We will inform you if we exclude you from our register and you will have the right to appeal.
Have you or anyone in your household been involved in any type of behaviour that can be classed as anti-social or nuisance behaviour in the last 5 years?
*
Yes
No
If yes, please give details
*
Have you or anyone in your household been convicted of a crime?
*
Yes
No
Offence
*
Date of conviction
*
Sentence received
*
Sentence served
*
Have you or anyone in your household ever been in trouble with the police in any other capacity, e.g. caution?
*
Yes
No
If yes, please give details
*
Have you or anyone in your householdever been made bankrupt or had any court orders made against you?
*
Yes
No
If yes, please give details
*
Any other relevant information which you think may help your application
Section 8: Documents required
You must provide original documents - not photocopies - to prove that you are eligible to rent a property in the UK. You must bring them to us yourself at our head office at Champagne House, 94 Corporation Street, Stoke on Trent ST4 4AY, or speak to us to make other arrangements. If you do not do this you will not be offered a home.
What you need to bring:
Your passport
Your National Identification card
Your residence card
Your current immigration status documents provided by the Home Office
If you cannot supply the above, you must bring two of the following:
A full birth certificate or adoption certificate issued in the UK
A current full or provisional UK driving licence
Original benefit paperwork issued by HMRC, the local authority or JobCentrePlus on behalf of the Department of Work and Pensions
Your current immigration status documents provided by the Home Office
Section 9: Data protection
By submitting this application form you are giving Trentdale Investments Ltd permission to store personal and sensitive data about you on our computerised housing register. The information you have given on this form will be stored on our computer system. Our staff will use it when they are letting homes. You are allowed to inspect the information we hold about you on our computer system. We may charge a reasonable fee for this (not exceeding the maximum fee from time to time set down by Parliament). This information is supplied to you to comply with the provisions of the Data Protection Act 1984 as amended from time to time.
Section 10: Declaration
I/we hereby certify that the details on this form are correct and i/we will notify Trentdale Investments Ltd if my/our circumstances change. I/we understand that any false or misleading statement or witholding any relevant information now or later might lead to me/our application being cancelled or any tenancy granted to me/us being ended. i/we hereby authorise any person or body to disclose to Trentdale Investments Ltd any information it requires, including financial details. I understand that my landlord or any other authorised agent may submit or receive information about myself, and any person(s) who legally and properly share the accommodation which either intend to or currently reside. This information will only go to those authorised by the North Staffordshire Landlords Association Limited, acting within the principles of the Data Protection Act 1998.
I further understand that I may, at any time, upon payment of a statutory fee (not exceeding £10), request in writing from the database administrator a copy of the details held on me, the data subject.
False information knowingly supplied for the purposes of gaining a tenancy may render the tenant/applicant liable to damages for all losses and expenses incurred.
To signify you have read and agree with the conditions above, please click this box.
*
I have read and agree with the conditions above
Please click here to view our privacy policy
To signify that you have read, understood and consent to the use and storage of your data outlined in our privacy policy, please click this box.
*
I have read and understood the privacy policy
Name
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