Harborough Homesearch

Thursday, 09-Sep-2010

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>New household registration

New household registration

Details

Personal Details

Title:*

First name:*

Surname:*

Date of birth:* (dd/mm/yyyy)

Gender:*

National Insurance Number:*

We keep records of the racial/ethnic origin of everyone applying for housing. This is to ensure through monitoring, that housing is provided on an equal basis to all. This information is provided in confidence and will not affect your application.

Ethnic Origin:*

If Other selected please give details:

Transgender Status

Is your gender identity the same as it was assigned at birth?

Sexual Orientation:

Religion or Belief:

Does this household member have a disability:*

Disability information:

Is this household member pregnant? yes no

If yes, when is the baby due? (dd/mm/yyyy)

Current Address Details

Address 1:*

Address 2:*

Address 3:

Address 4:

Address 5:

Postcode:*

Date moved in to this address:* (dd/mm/yyyy)

Home telephone:

Mobile telephone:

Email:

Other details

Are you subject to immigration controls, for example an asylum seeker?*

Have you been living abroad and returned to the UK, Republic of Ireland, the Chanel Islands or the Isle of Man within the last 12 months?*

Are you related to any Councillor or employee of Harborough District Council or to any board member of employee of any Housing Association particpating in Harborough Home Search:*

If yes, please state the following: Name of person, position and nature of relationship.:

Have you been convicted of a criminal offence (other than driving offence):*

If yes, please provide: Date of conviction, reason and sentence received. :

Employment Details

Which option best describes your current economic status?

What is your gross household income (before tax and other deductions)?

Do you and/or your partner have savings or investments?

If yes, please state how much?

If you own a property approximately how much money would you receive if you sold it, after you had paid off the mortgage and any other debts?

Current landlord

Which local authority do you live in?*

Who is your current landlord?*

If other selected, please provide details:

Contact address

Same as current address? yes no

If yes, then please ignore the following address fields

Address line 1:*

Address line 2:

Address line 3:

Address line 4:

Address line 5:

Postcode:*

Email:

Correspondence Telephone: