Halis Court

Application

Please tell us which scheme you are interested in:*

Please select the name of the development:*

If resale, please provide the property address:

What property type are you looking for?*

Please specify the property type*

What size property are you looking for?*

Do you have any specific housing requirements (for example, ground floor due to mobility reasons)?*

Yes

No

If yes, please provide details here:*

How did you hear about the scheme? (multiple choice)*

Site signage

Social media

Pine Court Housing Association’s website

Rightmove

Zoopla

Email

News

Word of mouth

Other (please specify)

This application is:*

About You

Please tick one or more that apply to you:*

First time buyer

Unable to purchase without assistance

Relationship breakdown

Over 55 and living in unsuitable accommodation

Other (please specify)

Prefer not to say

Title*

If other, please specify

First name*

Middle name/s*

Last name*

Date or birth*

Gender*

If other, please specify

What are your preferred pronouns?*

If other, please specify

Is your gender identity the same as the sex assigned to you at birth (optional)

Which of the following best describes your sexual orientation?*

If other, please specify

Are your day-to-day activities limited because of a physical or mental health problem or vulnerability?*

(Please note, this includes any problems related to old age)

If you answered ‘Yes’ to the question above, please indicate your vulnerability below

(Please tick all that apply)

If other, please specify

Do you require Pine Court Housing Association to make alternative arrangements due to your vulnerability?*

Yes

No

If yes, please explain in the box below. For example:

Physical disability > you require more time to answer the door. Hearing impaired > you require us to knock louder on door / BSL Interpreter. Visual Impairment > you require a large print magnifier

Ethnicity*

if other, please specify

National identity*

If other, please specify

Are you proficient in communicating in the English language?*

I can speak English

I can read English

I can write English

If you answered ‘No’ to any of the above questions, what is your preferred language?

Religion*

If other, please specify

Economic Status*

If other, please specify

Are you, or have you previously served in the Armed Forces?*

Do you have caring responsibilities?*

None

Primary carer of a child / children (under 18)

Primary carer of a disabled child / children

Primary carer of disabled adult (18 and over)

Primary carer of an adult (over 18)

Secondary carer (another person carries out the main caring role)

Prefer not to say

Other

If other, please specify

What is your current legal marital or civil partnership status?*

If other, please specify

Current address*

街道地址地址行 2 城市 County Postcode 国家

Time at this address*

Please provide details of your previous address(s)*

Which local authority area do you live in?*

Which local authority area do you work in?*

Phone number*

Email address*

National Insurance number*

Details of your next of kin*

Name

Phone number

Email address

Are you a UK citizen?*

Yes

No

If you answered no, do you have indefinite leave to remain in the UK?*

Yes

No

What is your current living situation?*

If you are renting, are you in rent arrears?*

Yes

No

Do you have a history of rent arrears?*

Yes

No

If you are currently renting, have you ever broken the terms of your Tenancy Agreement?*

Yes

No

If you are currently renting your home, please state the name of your landlord.*

If you are currently renting your home, please provide the contact details of your landlord.*

Please provide contact details of someone we can contact to request a reference.*

If we accept your application, we will need to request a reference before we can offer you a property. We will tell you before we make a request. Please confirm you are happy for us to request a reference.*

Yes

No

Declaration

Please read the text below and tick the box to say you have read and agree to the declaration.

We will only process the given personal data of all applicants for the purpose of processing your application for housing and will hold information in accordance with data protection laws including the General Data Protection Regulation and the Data Protection Act 2018.

We may also share this information for the same purposes with other organisations that handle public funds. The information may be used for statistical surveys, which means we may pass this information in confidence to the Department for Communities and Local Government and agencies working on our and their behalf who may contact you.

All information you give us on this form (and information resulting from contact with your Landlord and/or employer) may be shared with the same only in relation to this application.

All information will be treated in the strictest confidence. We reserve the right to take up any references relating to applicants as we consider it necessary and may also search the files of any credit reference agency which we will keep a record of any such request.

We must protect the public funds we handle and so may use the information you have provided on this form to prevent and detect fraud. Under data protection law the information may be disclosed for the purposes of crime prevention and detection. Sensitive personal data such as racial or ethnic origin, offences (including alleged offences) and physical and mental disabilities are required under the Equal Opportunities Monitoring Statute.

By ticking this box you confirm that you have read the above declaration and that all the information you have provided in your application is true and accurate.

The data we collect will only be used for the purpose of assessing your application for our Rent to Buy product to determine your eligibility. If you subsequently decide not to proceed with this application, you can contact us to have your information removed. Please refer to our Privacy Notice.

Halis Court

Shared ownership application

Application

About You

Employment and Financial Information

About applicant two

Applicant two employment and financial Information

Declaration