Accommodation Application Form

1. Under which category for housing are you applying?

Which Housing Category?*

Direct Waiting List
Pathways Internal Transfer
Other Referral

Which Housing Scheme?

If you know the name of the scheme you wish to apply for, please specify it below:

Other Referral*

Please provide details, including the name of the organisation.

2) Personal Details

Full Name*

Date of Birth*

DD

MM

YYYY

Marital Status

National Insurance Number*

Please provide your National Insurance Number. It’s on your National Insurance card, benefit letter, payslip or P60. For example, ‘QQ 12 34 56 C’.

Are you a citizen of the UK or elsewhere in the European Union?*

Yes
No

Are you subject to immigration control?*

Yes
No

Proof of Status and Eligibiity*

Drop files here or

As you are not a UK/EU citizen or are subject to immigration control, you will need to provide a copy of your status papers and proof of your eligibility for social housing. Allowed files include jpg, jpeg, gif, png, bmp, pdf & tif. Maximum of 7Mb per file. Up to 10 files allowed.

Is this a joint application with another person?*

Yes
No

Name of Joint Applicant*

Please provide the name of the person you applying for a joint application with. Pathways may request further information about the joint applicant at a later date.

3) Contact Details

Telephone (Home)

Telephone (Work - If applicable)

Mobile Phone

Email address*

Enter Email Confirm Email

Next of Kin / Emergency Contact Details

Next of Kin Full Name	Relationship to you	Actions
		Edit Delete
There are no Next of Kin.

Maximum number of next of kin reached.

Please provide the contact details for one, but ideally two people who can act as your next-of-kin and be contacted in the event of an emergency.

4) About your present home

Full Address*

Please provide us with your full address below:

Street Address Address Line 2 City Postal Code Country

Proof of current address*

Please send us a photocopy of your passport or driver’s license AND two utility bills or bank statements as proof of current address. Allowed files include jpg, jpeg, gif, png, bmp, pdf & tif. Maximum of 7Mb per file. Up to 50 files allowed.

Drop files here or

How long have you lived at this address *

Number of Years*

Number of Months*

Other places you have lived in past 2 years

As you have indicated you have lived at your present address for less than 2 years, please provide the address(es) of the other place(s) you have lived in the past 2 years.

Previous Address	Actions
	Edit Delete
There are no Entries.

Maximum number of entries reached.

What kind of accommodation are you currently living in?*

Which of the following facilities do you share with others?*

Where you currently live, are you:*

The Private Rented Tenant
Living with family and/or friends
Homeless
Other

Landlord's Name*

Prefix First Last

Landlord's Address*

Street Address Address Line 2 City Postal Code Country

Landlord's Phone*

5) Expenditure, Income & Savings

Do you pay rent?*

Yes
No

How much is your rent?*

Please enter a number from 1 to 5000.

How often?*

Weekly
Monthly

Do you have any rent arrears?*

Yes
No

How much are your rent arrears?*

Please enter a number greater than or equal to 1.

Please explain why you are in rent arrears*

Have you ever been served with a Notice due to non-payment of rent?*

Yes
No

Please explain the circumstances of the Notice*

What other payments do you currently make?

Please provide average monthly amounts for all those that apply. Enter zero for those that do not apply.

Electricity*