Application Number (for office use only):
Applicant's Name:
*
Sex: *
Male
Female
Date of Birth: *
Present Address: *
Telephone (home):
Telephone (mobile):
Email Address: *
Your Family or Household: Please fill in the details of each person living with you in your present home, even if they will not be moving with you. Also list any other people who live elsewhere at the moment, but who will need housing with you if you move to a Muir Group home.
Name: *
Sex: *
Male
Female
Date of Birth: *
Relationship to you: *
Is this person living with you now? *
Yes
No
Will this person need rehousing with you? * Yes
No
Name:
Sex: Male
Female
Date of Birth:
Relationship to you:
Is this person living with you now?
Yes
No
Will this person need rehousing with you? Yes
No
Name:
Sex: Male
Female
Date of Birth:
Relationship to you:
Is this person living with you now? Yes
No
Will this person need rehousing with you? Yes
No
Name:
Sex: Male
Female
Date of Birth:
Relationship to you:
Is this person living with you now? Yes
No
Will this person need rehousing with you? Yes
No
Name:
Sex:
Male
Female
Date of Birth:
Relationship to you:
Is this person living with you now? Yes
No
Will this person need rehousing with you? Yes
No
Name:
Sex: Male
Female
Date of Birth:
Relationship to you:
Is this person living with you now? Yes
No
Will this person need rehousing with you? Yes
No
What type of house do you live in now? * House (Terraced/Semi-detached/Detached)
Flat (Ground Floor)
Flat (Above Ground)
Bedsit
Prison/Hotel/Hostel
Bed & Breakfast
Mobile Home / Caravan
Bungalow
Other
At your present home, do you have the use of any
Living Room *
Yes
No
If you have to share with another family or
Separate Kitchen: * Yes
No
If you have to share with another family or
Bedroom: * Yes
No
If you have to share with another family or
Bathroom: * Yes
No
If you have to share with another family or
Outside WC: * Yes
No
If you have to share with another family or
Inside WC: * Yes
No
If you have to share with another family or
Hot Water Supply: * Yes
No
If you have to share with another family or
Has your present accommodation ever been declared *
Yes
No
How many bedrooms do you have in your present *
How many bedrooms do you have for you and your *
At your present address, are you: *
The Owner
A Tenant
A Lodger
Living in Tied Property
Living with Relatives
Living with Friends
If you are a tenant, do you rent accommodation * Yes
No
If you are not the owner, please give the name and *
How many years have you lived at your present *
If you have lived at your present address for less than 3 years, please give details of your other previous addresses for the last 3 years:
Previous Address 1 *
From: *
To: *
Reason for leaving: *
Previous Address 2: *
From: *
To: *
Reason for leaving: *
Previous Address 3:
From:
To:
Reason for leaving:
Employment: Please give details of yourself and everyone who will be living with you and who is working:
Name: *
Employer: *
Job: *
Length of Employment: *
Weekly Take Home Pay: *
Name:
Employer:
Job:
Length of Employment:
Weekly Take Home Pay:
Name:
Employer:
Job:
Length of Employment:
Weekly Take Home Pay:
Pensions and Benefits: Please give details of yourself and everyone who will be living with you and who receives a pension or benefit:
Name: *
Type of Pension/Benefit: *
Amount (£): *
Name:
Type of Pension/Benefit:
Amount (£):
Savings: Please give details of yourself and everyone who will be living with you who has any savings:
Name:
Type of savings account:
Amount (£):
Name: *
Type of savings account: *
Amount (£): *
Name:
Type of savings account:
Amount (£):
Equal Opportunities: Muir Group intends to ensure that all applicants receive equal treatment regardless of race, colour, ethnic or national origins. In order to assist us in checking this policy is carried out, it would help if you could complete the following:
I would describe my nationality as: *
African
Asian
South East Asian
Caribbean
British
Irish
Other European
Other
I would describe my colour as: *
White
Black
Mixed
Other
Spouse's ethnic origin:
More details about your origin:
Declaration of Interest Muir Group is forbidden to give preferential treatment to its employees, committee members or their close relatives. Nor is it allowed to give preferential treatment to its contractors, consultants, suppliers or their close relatives. In order to assist us in complying with the law, please confirm if you are an employee or committee member of the Association, or a close relative of one. Please also confirm if you are a contractor, supplier or consultant currently working for the Association, or a close relative of one.
Declaration of Interest:
Other Housing applications If you have applied for council housing, please provide the name of the council and any reference number you have for your application.
Other Housing applications:
If you have applied to another housing
Housing Required It may not be possible to offer you exactly the housing you want. The more options you give, the better your chance of receiving an offer. Please list the estate(s) or area(s) where you want to live:
Area housing required in: *
Do you want (tick all that apply): *
A House Only
A Flat Only
Ground Floor Only
A House or Flat
A Bungalow
Any Floor
How many bedrooms do you want? *
If stairs are a problem: *
Elderly applicants only
Elderly applicants only:
Yes
No
Extra Information
Please provide any further information you wish about why you want to move from your present accommodation, the type of housing you want, or anything else you feel is important to your application:
Extra information:
Statement
The above information is a true statement. I understand that Muir Group reserves the right to take action for possession of any accommodation if it has been obtained by deliberately providing false information.
Please tick to confirm you agree with the above *
Yes
No
Name: *
Date: *
Our aim is to assist you.
To help us to do so, please provide as much information as possible. If you require help filling out your housing application form, please contact our Customer Services Team, who will be happy to help you with the form in person or over the phone. They can be contacted on 0300 123 1222.
Please tick any that apply to you:
Audio Tape/CD
Correspondence in large print
Translation/Interpretation
Sign Language
Correspondence in Braille
Correspondence via Textphone
Correspondence via telephone
Other
Additional Information
You may wish to provide additional information which you think would assist us in considering your application. A list of possible factors which may assist us are shown below. Please only provide contact details in relation to those factors relevant to you or a member of your household.
Examples:
If you are an owner-occupier and your home is being repossessed - Building Society or Bank
If you are wishing to move for employment reasons - Employer
If you or anyone wishing to move with you has any health reasons for moving, or that will affect the type of accommodation you wish to be considered for - Doctor, Health Visitor etc.
If you are receiving support or care from any agency - Social Services, Charities, Probation Services etc.
If you are or have been suffering from any form of harassment, including domestic violence - Police, Social Services
If you are receiving support or assistance from any local authority ageny - Housing Department, Education Authority, or any similar body (eg. another Registered Social Landlord)
Please note that this list provides examples only. If you feel that there are other agencies that are relevant to your housing application, please give details.
Contact Name 1: *
Address: *
Telephone Number:
Details:
Contact Name 2:
Address:
Telephone Number:
Details:
Tailoring Our Services
If there are any other ways in which we can tailor the way we provide our services to you, please tell us:
Service improvements:
References
All applicants are asked to complete the following sections. Muir Group will contact your current or (wherever relevant) previous landlord(s)
Your Name: *
Your Address: *
N.I. Number: *
Date of Birth: *
If this is a joint application, please give details of the second applicant below.
Name (joint applicant):
Address (if different):
N.I. Number:
Date of Birth:
Current Landlord: *
Previous Landlords (if less than 3 years at *
Police Checks
Please note that police checks may be carried out. Muir Group wishes to assist all applicants as fully as possible. Every applicant will be treated fairly and in a non-discriminatory manner. However, we must also consider the needs and the rights of our existing residents, and must ensure that communities are maintained as stable, sustainable environments. Only serious and/or relevant activities (eg. anti social behaviour) committed during recent years will be taken into account.
I/we authorise Muir Group to make the necessary enquiries before offering me/us a tenancy
I/we understand that this may involve the divulging of information covered by the Data Protection Act.
I am/We are aware that this may involve Muir Group contacting various appropriate agencies on my/our behalf.
I/we give consent to relevant information being provided to Muir Group by the agencies concerned. This consent is given with regard to all persons who are intending to live with the applicant(s)
I/we acknowledge that Muir Group will not divulge this information to any third party without further consent
Name: *
Date: *
Name (joint applicant):
Date:
Additional Information:
Image Verification
