Apply for a House

Notes on how to complete this form can be downloaded here

Before you start

It is important that the notes accompanying this application are read before the form is completed. If housing is required by two people currently living apart, then two seperate forms should be completed. The completion of this application should not be taken as an indication that a house will eventually be offered to the applicant.

1. Personal information

Name

Date of birth

Address (including postcode)

National Insurance Number

Telephone number

Mobile number

2. Previous addresses

Please give details of your previous addresses:

Previous Address 1

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 2

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 3

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 4

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 5

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 6

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 7

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 8

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 9

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 10

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 11

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 12

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 13

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 14

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 15

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 16

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 17

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 18

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 19

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 20

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 21

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 22

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 23

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 24

Address

From Date

To Date

Tenure

Reason for leaving

Previous Address 25

Address

From Date

To Date

Tenure

Reason for leaving

Please give details of previous landlords and addresses if applicable:

4. Tenure type

Which of the following categories applies to you?

Please specify:

Name & address of current landlord

5. Size of household

How many people live in the house, including yourself:

Who are they?

Person 1

Name

Relationship to you

Date of birth

Person 2

Name

Relationship to you

Date of birth

Person 3

Name

Relationship to you

Date of birth

Person 4

Name

Relationship to you

Date of birth

Person 5

Name

Relationship to you

Date of birth

Person 6

Name

Relationship to you

Date of birth

Person 7

Name

Relationship to you

Date of birth

Person 8

Name

Relationship to you

Date of birth

Person 9

Name

Relationship to you

Date of birth

Person 10

Name

Relationship to you

Date of birth

Person 11

Name

Relationship to you

Date of birth

Person 12

Name

Relationship to you

Date of birth

Person 13

Name

Relationship to you

Date of birth

Person 14

Name

Relationship to you

Date of birth

Person 15

Name

Relationship to you

Date of birth

Person 16

Name

Relationship to you

Date of birth

Person 17

Name

Relationship to you

Date of birth

Person 18

Name

Relationship to you

Date of birth

Person 19

Name

Relationship to you

Date of birth

Person 20

Name

Relationship to you

Date of birth

Person 21

Name

Relationship to you

Date of birth

Person 22

Name

Relationship to you

Date of birth

Person 23

Name

Relationship to you

Date of birth

Person 24

Name

Relationship to you

Date of birth

Person 25

Name

Relationship to you

Date of birth

What are the sleeping arrangements:

Living room:

Bedroom 1:

Bedroom 2:

Bedroom 3:

Bedroom 4:

Other Bedrooms:

Details of persons to be rehoused with you and their present address if different to your own; If you have access to a child please state how many nights they stay with you and provide written confirmation from an ex-partner or lawyer. Further evidence may be required at a later date.

Person to be rehoused with you 1

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 2

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 3

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 4

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 5

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 6

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 7

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 8

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 9

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 10

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 11

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 12

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 13

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 14

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 15

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 16

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 17

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 18

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 19

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 20

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 21

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 22

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 23

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 24

Name

Address

Relationship to yourself

Date of birth

Person to be rehoused with you 25

Name

Address

Relationship to yourself

Date of birth

7. Sexual offences declaration

Have you or any member of your application been convicted relating to Sexual Offences or must register with the police under The Sexual Offences Act 2003?

Yes No

Please give details:

Strict confidentiality of this information will be observed, although transfer of this information will be made to the council's designated officer, in charge of monitoring and liaison with the police.

8. Arrears

Do you owe any arrears of rent / mortgage to your current or previous landlord or lender?

Yes No

Please give details:

9. South Lanarkshire Council

We recommend that you apply to South Lanarkshire Council for housing. Contact the Questions & Answers office to obtain a Homefinder application form: 0845 740 6080

Are you on the SLC homeless list?

Yes No

Please provide a copy of your homeless letter

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10. Connection to RCHA

Are you, or is anyone else in your household, related to or otherwise connected with a member of the RCHA Management Committee or staff?

Yes No

Please give details:

11. Reason for application

To assist us in pointing your application, please use the space below to provide any further details of why you require housing, in particular, any special circumstances which you feel should be considered when your application is being assessed?

13. Monitoring Information

Ethnic origin

Please state how many people in your application have a Disability

Please select all that apply

Mental Health
Physical
Learning Difficulties

14. Declarations

The following declaration should be read carefully before signing

At least one piece of recent documentary evidence confirming your residence at the address you are applying from must be included with this application; This could be a photocopy of a benefit book, bank statement, or some recent mail. Further proof may be required at a later date.

Failure by you to produce this information will result in your application being returned.

Documentary evidence

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I certify that the information given in this application is correct and complete, and I consent to the Association making such enquiries as may be necessary to confirm the information provided by me.

I AGREE

I agree to advise the Association of any change of circumstances which may affect this application. I understand that any false or misleading information, or information deliberately withheld, may result in the suspension or cancellation of my application, or any offer of tenancy being immediately withdrawn, or where a tenancy has been granted this may result in action being taken to terminate the tenancy.

I AGREE

Your Account

Housing