Co-Operative Housing in South East London Ltd
For use by
FLAMENCO HOUSING CO-OPERATIVE
CO-OPERATIVE HOUSING IN SOUTH EAST LONDON LTD.
118A Brockley Road, London, SE4 2RN
Tel: 020 8692 5258.
SHARED HOUSING APPLICATION
PERSONAL DETAILS
NAME: / OCCUPATION:PRESENT ADDRESS:
EMAIL ADDRESS: / EMPLOYERS NAME & ADDRESS:
TELEPHONE NO: / PLACE OF WORK:
NET SALARY:
EMPLOYMENT NO: / WORK FAX NO:
N.I. NUMBER / D.O.B/AGE
NEXT OF KIN, NAME & ADDRESS / NEXT OF KIN RELATIONSHIP TO YOU:
STATUS: / M / F:
YOUR PRESENT HOME
Do you live in a house? / a bed sit?a flat? / other e.g. hostel, B&B?
a maisonette?
Which floor? ......
Please state the name and addresses of all the people you want to be rehoused with you, starting with your own name:-
Name / Age / Sex / Relationship to youIf any of the above are not living at the same address as yourself, please state their present address and why they are not living with you:-
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Is your present accommodation:- please tick box
a council tenancy?a housing association tenancy?
a co-operative tenancy?
an assured shorthold private tenancy?
a license?
staying with friends/family?
bed & breakfast/hostel?
owner occupied?
other? (please give details)
Details ......
How many rooms do you currently have for your own use?
Living room(s) / KitchenBedroom(s) / Bathroom
Separate toilet
Do you share any of the above with anyone who is not a member of your household?
Yes / NoIf yes please give details ......
Please describe the repair of your present accommodation:-
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How much rent do you pay? ......
We will contact your current Landlord to confirm details of your tenancy/license.
How long have you lived at your current address? Years...... Months ......
If less than two years, please state below where you have lived in the previous three years.
1......
2......
3......
4......
5......
HOUSING NEED
Please use this space to tell us why you want/need to be rehoused and to give other information you think is important and any factors that you feel may effect your application.
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LANDLORD
If you rent or license your home, please name your landlord and give their address:-
Name ......
Address ......
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If your landlord is a local authority, housing association, co-operative or private landlord, please provide a suitable rent reference or other evidence (e.g. rent book & rent statement) that you pay rent.
Are you on the waiting list with the Council?
Yes / NoIf yes, please state which one ......
Waiting list number ......
How did you find out about Flamenco Housing Co-op?
Member of the co-op / Chisel Housing AssociationFriend / Other
Local Council
If other, please state ......
Please state the reasons why you would like to live co-operatively in preference to any other type of accommodation.
Why do you feel that living in a Co-operative is similar to employment?
Please outline the skills which you have that would help us in the running of the Co-operative.
How many hours per month can you volunteer to the Co-operative?
MEDICAL PROBLEMS
Do you have any disabilities or medical reasons why you need rehousing?
Yes / NoIf yes, please give details ......
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Please give Doctors details
Name of Doctor ......
Address ......
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Post code ......
Telephone no. (incl.STD code) ......
Do you have a Social Worker
Yes / NoIf yes, please give Social Workers details
Name of Social Worker ......
Address ......
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Post code ......
Telephone no. (incl.STD code) ......
Do you smoke?
Yes / NoDo you have pets?
Yes / NoIf yes please give details......
Have you a problem of racial, sexual or other serious harassment in your present accommodation?
Yes / NoIf yes, please give details ......
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Please provide evidence of harassment (e.g. police, medical, social services referrals).
INCOME & EMPLOYMENT
What is your source of income?
Income SupportInvalidity/Disability Benefit
Pension
Employment
Student grant/loan
Job Seekers Allowance
Other
Other, please specify ......
IMPORTANT INFORMATION
If you are made an offer of accommodation, we will require three forms of I.D. Acceptable forms of I.D. are:-
Birth Certificate
National Insurance Card
Medical Card
Passport
Social Security Books
Bank Account Details
Driving License
Student I.D Card
At the viewing, you will be accompanied to the property by a Co-op member. The existing sharers will be informed in order to provide an opportunity to meet in private with you as a potential tenant.
Finally
I certify that the above information is correct and I understand that giving false or inaccurate information will disqualify my application.
Signed ...... Date ......
Please return this form to: Flamenco Housing Co-op
Allocations Officers
Flat B
19 Waller Road
New Cross Gate
London
SE14 5LE
EQUAL OPPORTUNITIES
CHISEL is committed to equal access to housing for everyone, irrespective of age, sex, race, marital status, sexual orientation or religion.
To help us assess wether our policy is effectively carried out, we ask you to help by answering this question. However, you do not have to answer this question.
I would describe my ethnic origin as:-
Please tick. Add further details if you wish.
Black - AfricanBlack - Afro Caribbean
Black - Other / (specify)
Asian - Indian Sub-Continent
Asian - Chinese/Vietnamese
Black British
Irish
White British
White - Other / (specify)
Other / (specify)
Chisel Limited is a Charitable Housing Association
registered under the Industrial & Provident Societies Act 1965 No. 25155R, and the Housing Act 1985 L3642