Shared Housing Application Form

Retrieve Existing Application

Please be aware that Shared Habitat cannot guarantee you an offer of accommodation, and that any accommodation offered will be shared with other people

Date of application

Personal Details

Salutation *

First Name *

Last Name *

Email *

Date of Birth *

Gender *

Mobile *

National Insurance number

Contact address

Are you currently homeless

Emergency contact (EC) name, address and contact number

EC relationship to you

Immigration status (Pick one)

Other (please provide further details)

Housing situation what is your current housing situation? (Pick one)

Other (please provide further details)

Have you ever stayed in a hostel?

If yes, where?

How long for?

Has your landlord given you written notice to leave your current accommodation?

Have you been told by the court that you have to leave your current accommodation?

Have you ever slept rough?

When was the last time you slept rough?

Additional Support

Do you consider yourself to have a disability?

Are you registered disabled?

Are you currently taking any medication?

Please provide details of any relevant current / past physical health problems and medication taken that we may as your landlord need to be made aware of

Income

How would you describe your current employment status? (Pick one)

If you are currently employed, what is the length of your contract?

What is your income per week after you’ve paid tax and National Insurance?

Are there any other deductions to your pay (e.g. attachment of earnings)?

Are you currently in receipt of any benefits?

If yes, which benefits and how much do you receive each week?

Do you get any income from anywhere else, e.g. maintenance?

Please give any further relevant information regarding current/future income

Proof of Identity

Other (please specify)

Do you have a bank account?

Do you have any debts?

If yes, what are they and what are your payment arrangements?

Are your financial circumstances about to change?

If so, how?

Offending History

Have you ever been convicted of a criminal offence?

If yes, give dates and full details of all previous offences and sentences

Housing Preferences

Which geographical areas would you most like to live?

Do you have any children?

If so, how many?

How would this affect your accommodation needs?

Are there any other factors which may affect the suitability or otherwise of a property that we need to be aware of?

Permission Statement

Shared Habitat Ltd. allocates accommodation according to housing need and the suitability of individual properties. You should read this carefully before you proceed.

1. I declare that the information given on this form is true to the best of my knowledge.

2. 1 understand that if Shared Habitat Ltd. offers to provide a tenancy on the basis of a false statement made by me or misleading information; or if I withhold information which I am supposed to declare then the application may be cancelled.

3. If I were granted a tenancy because I have given false or misleading information, or because I have not given information that I am supposed to give, or have failed to inform Shared Habitat Ltd. if my circumstances change, it is an offence and my tenancy my be terminated and I may have to pay a fine of up to £5000 under Section 171 of the Housing Act 1996.

4. I authorise Shared Habitat Ltd. to make whatever enquires are necessary before they can confirm acceptance onto a waiting list or make an offer of a property.

5. I authorise any relevant agencies to disclose to Shared Habitat Ltd. whatever information is requested as part of this investigation.

6. I authorise Shared Habitat Ltd. to carry out a credit referencing check as necessary.

7. I must inform Shared Habitat Ltd. immediately if any of my circumstances change.

Confidentiality and Data Protection

Information provided on this application will be held and used in accordance with the

Data Protection Act 2018.

Shared Habitat Ltd. will only process data provided by the applicant and supplied to any

third parties for the purposes of processing this application and to manage any subsequent

tenancy.

Information will be kept confidential and will only be disclosed to third parties on the basis

that the information remains thus. The disclosure of such information will be strictly limited and

will only be supplied for the purposes of dealing with this application or as required or permitted by law.

I confirm that I have read and fully understand and accept the terms above.

Full name of the applicant

Date

Personal Details
Additional Support
Income
Proof of Identity
Offending History
Housing Preferences

By submitting your application you are agreeing to the following terms:

I conﬁrm that the information provided in this application form is true to the best of my knowledge.
I am happy for my details to be used for the purpose of referencing and for my chosen contacts to be contacted (including those outside the EEA), with personal information which has been provided in this form to allow them to verify the information about my earnings, dates of employment and previous tenancy term.
I agree to all data I submit being stored online in compliance with Arthur Online's GDPR and Privacy policies.

If you do not agree with any of these terms, do not submit your application form.