oxford city council - general housing register form · housing needs oxford city council ....

www.oxford.gov.uk

Housing Needs Oxford City Council Applications Team 109-113 St Aldates Phone: 01865 249811 Oxford OX1 1DS Email: [email protected] Dear Applicant Please either scan or photograph the completed application form and return to [email protected] In the email subject please include your surname, first initial and if applicable your housing reference number with Oxford City Council. To complete the application form you will need to open it using Adobe Acrobat Reader which is freely available via the internet. As part of your application, please supply a secure email address in your application form. This will be used for correspondence and will be required to set up your account should your application be successful. Please make sure that you fully complete the application form, including your address information. If you currently have no fixed address you must provide a correspondence address. Failing to provide this information will result in delays and may result in your application being unable to be registered. The following information will be requested to support your application. To facilitate the processing of your application please send a scan or photograph of the documents below where available with your application form. If you are unable to email the application form or documents, they can be posted to the address above, however please do not post any original documents in to the city council offices. Identification for each applicant over 18:

Passport, driving licence, residents permit or if you do not have either of these, a long birth certificate with any immigrations documents.

Identification for each applicant under 18: Long birth certificate along with child benefit and child tax credit aware letters.

Proof of address: Tenancy agreement, license agreement or letter from current head of household. If you are no fixed abode you will need to request a NFA questionnaire and supply letters from any friends or family you stay with.

Proof of capital: Latest 3 months’ bank statements for all bank, building society, savings accounts and post office accounts for each applicant over 18.

Proof of income: 3 months’ worth of wage slips and all benefit award letters.

Full 5 year address history: This should include the tenure you held, details as to how many bedrooms you had access to and your reason for leaving.

National insurance number for each applicant over 16

General Housing Register Form

mailto:[email protected]

mailto:[email protected]

www.oxford.gov.uk

Landlords Reference:

Please provide either an up to date rent statement and a letter from your current landlord confirming you have no rent arrears or tenancy issues. If you cannot provide this, please provide a written and signed statement to confirm why you could not obtain the reference. Please include your full name and address in this statement.

Please note that the above information is the minimum we require to assess your application and further information may be requested at a later date. We will not be able to start processing your application without all of the above documents and fully completed general register application. If you have any difficultly providing this information, please contact us to discuss it. The quickest solution to your housing problem is for you to look at the private rented sector for alternative accommodation using local lettings agents www.rightmove.co.uk. You may also qualify for financial support with Housing Benefit which may assist you with paying your rent. Please call 01865 249811 for a housing benefit calculation. Upon receipt of your fully completed general register application form and the documents requested above, we will write to you once we have assessed them and updated our records accordingly.

Yours sincerely,

Housing Needs Team

http://www.rightmove.co.uk/

OXFORD REGISTER FOR AFFORDABLE HOUSING

The Oxford Register for AffordableHousing is a partnership between

Oxford City Council and theRegistered Providers listed on the

back page of this form

Housing Application for Inclusion onthe General Register List in Oxford

Oxford City Council Customer Service Centrescan help you with your housing application form

(call or drop in to make an appointment)

St Aldate’s Customer Service Centre Main Office (appointment only)

St Aldate’s Chambers109–113 St Aldate’s, Oxford OX1 1DS

T: 01865 249811

Templars Square Customer Service Centre(appointment only)

2–3 Bank Court, Templars Square, Cowley, Oxford OX4 3UZT: 01865 249811

Registered Provider Local Housing Officesin Oxford may also be able to help you with

your housing application form(call to check and/or make an appointment)

Catalyst Communities Housing Association The Farmhouse, Nightingale Avenue

Blackbird Leys, Oxford OX4 7BUT: 01865 712244

A2Dominion Housing GroupGodstow Court, 5 West Way, Oxford OX2 0GE

T: 0800 432 0077

GreenSquare Housing Group244 Barns Road, Oxford OX4 3RW

T: 01865 773000

For help, housing advice or tomake an appointment to returnyour application form to aCustomer Service Centre, contactthe Housing Needs Team

Incomplete forms will not beaccepted

Please ensure you answer allthe questions and bring inall supporting documents toyour appointment


Housing Application for Inclusion on the General Register List

This is a housing application form for inclusion on theGeneral Register List on the Housing Register in Oxford.

Before completing this form please read the importantinformation below:

� Social housing is scarce in Oxford and only a low number ofproperties become available to let each year in the City.

� Due to the high number of households applying for housing inOxford and the low amount of properties that become available,only households in high housing need are likely to receive an offerof housing and they may have to wait many years before theyreceive an offer of housing.

� There are not enough properties in Oxford to house all thoseapproaching the Council for housing assistance. The majority ofhouseholds are unlikely to receive an offer of housing, even if theyare included on the General Housing Register, and they shouldconsider other housing options instead.

� Completing this form does not guarantee you will be includedon the General Housing Register or be made an offer of housing.

� By completing this form you are applying to be included on theCouncil’s Housing Register and your application will be assessedunder the criteria set out in the Council’s Allocations Scheme(a summary and full version of the Allocations Scheme is availableon the Council’s website, www.oxford.gov.uk).

� When completing this form please ensure you answer all thequestions fully and supply all the supporting documents listed asproof needed to support your housing application. Failure to doso will result in a delay in your housing application beingprocessed or your application may be cancelled.

� For advice about your housing options or assistance withcompleting this form, contact the Housing Needs Team onT: 01865 249811.

� We do not accept applications or original documents by post(if due to your circumstances you are unable to return yourapplication form to a local office please contact the HousingNeeds Team).

� If you are homeless, or threatened with homelessness, pleasecontact the Housing Needs Team to discuss your housing options.

About this form



Eligibility

Are you or your partner aged 18 years or older? Yes No

Are you a British citizen permanently resident in the UK or a person from abroad resident with

‘recourse public funds’? Yes No

If your answer is ‘yes‘ to both questions please continue, if it is ‘no‘ to either question you may not be eligible forhousing please call us for advice before completing the form.

Qualification

Do you or your partner have property, savings or investments of £16,000 or more in the UK or overseas?

Yes* No

* If you have savings and investments over £16,000 you may be eligible to apply for low cost home ownership orother Help to Buy options – if you are registering for this purpose please complete the full application form andensure you make this clear on the form.

Do you or your partner owe rent arrears and/or re-charges for damage for your current

accommodation? Yes No

Have you or your partner been evicted or left a property owing rent arrears and/or re-charges which

remain unpaid? Yes No

Have you, your partner or a member of your household been responsible for anti-social behaviour?

Yes No

If you have answered ‘yes‘ to any of the questions above you may not qualify for inclusion on the HousingRegister. Please contact us before proceeding. If you have answered ‘no‘ to all of the questions please continue.

This short self-assesment questionnaire is designedto help you decide whether it is worth applying forsocial housing before you complete the full form,bearing in mind that:

� Social housing in Oxford is very scarce and manymore people apply for housing than can beoffered social housing

� To be included on the General Register List youmust be eligible and qualify for an offer of housing

� The Council prioritises housing applicationsaccording to households’ housing needs

� If you are assessed as in low housing need, youare unlikely to be made an offer of housing even ifyou are eligible for housing and qualify for anoffer.

Housing Application Self-Assessment

Self-assessment continued on next page

A



B

Are you and your partner aged 60 years or older, with no other household members and interested in

applying for sheltered accommodation? Yes No

If you have answered ‘yes‘ please complete the full application form and ensure you make this clear on the form.

Do you have a local connection to Oxford?

By this we mean you or your partner have either: lived in Oxford permanently for 6 out of the last 12 months or

3 out of the last 5 years; have close family members that have lived in Oxford for at least the last 5 years; you or

your partner work in Oxford at least 16 hours/week? Yes No

If you have answered ‘no‘ please contact the Housing Needs Team as you are unlikely to qualify for inclusion onthe housing register unless you or your partner have been in the armed forces or you consider you have

exceptional circumstances for moving to Oxford.

Housing Need

1. Do you consider yourself to be overcrowded in your current accommodation? Yes No

2. Do you consider the condition of your current property is unsatisfactory? Yes No

3. Are you currently homeless or living in insecure accommodation and threatened with homelessness?

Yes No

4. Do you or a member of your household have a serious health issue or disability that is directly

affected by your current accommodation and would be improved by moving? Yes No

5. Do you or any member of your household have a serious social and welfare issue that is directly

affected by your current accommodation and would be improved by moving? Yes No

If you have answered ‘yes‘ to any of the above 5 questions you will be able to provide more details in the fullapplication form, please continue to fully complete the form.

If you have answered ‘no‘ to all 5 questions we do not recommend you continuing to complete thisform (unless you are 55 years or older and have no younger household members who need to move with you).

Housing Application Self-Assessment continued


1 Housing Application for Inclusion on the General Register List

Details about You and Your Household

Applicant Yes No Language

Joint Applicant Yes No Language

Surname Mr Mrs Ms Miss

First names

Current address

and postcode

Surname Mr Mrs Ms Miss

First names

Current address

and postcode

Applicant Joint Applicant


Home Home

Work Work

Mobile Mobile

Email Email

Applicant

Address

and postcode

Reason

01 Do we need to communicate with you in alanguage other than English?

02 Main Applicant� Proof neededIdentity of applicant and joint applicant• passport• birth certificate• driving licence

03 Joint Applicant (if applicable)�All proofs required will be needed for partnersas well.

�If you are applying with your partner then youshould both sign the form to confirm you areapplying as joint applicants.

04 Date of moving in to current address

05 Phone numbers/email addresses for us tocontact you

Correspondence address if different from above

You must state the reason why your current address is different from your correspondence address

06



Joint Applicant

Address

and postcode

Reason

Eligibility

Applicant

Joint Applicant

Applicant Yes No

Joint Applicant Yes No

Yes No

People to be Accommodated

Main ApplicantSurname Mr Mrs Ms Miss

First names

Date of birth (dd/mm/yyyy) Male Female

Relationship to applicant

NI No. In paid employment? Yes No

06 Correspondence address if different from above (continued )

You must state the reason why your current address is different from your correspondence address

10 Details of ALL people that you wish to beaccommodated with you (including yourself)

NI No. = National Insurance Number. Use for adultsonly�Proof neededIdentity for ALL people to be accommodated• passport• birth certificate• driving licence

07 What is your nationality?

08 Have you or your partner come to live in theUK, Republic of Ireland, Channel Islands or Isleof Man in the last 5 years?

� Proof neededPassport and Home Office UK Border Agency letter

09 Do you or anyone named in question 10 haveconditions or limits on the right to enter orremain in the UK, or is anyone on thisapplication subject to any immigration rules?

If ‘yes’ what are these conditions?



Joint ApplicantSurname Mr Mrs Ms Miss

First names




Second personSurname Mr Mrs Ms Miss

First names




Third personSurname Mr Mrs Ms Miss

First names




Fourth personSurname Mr Mrs Ms Miss

First names




10 Details of people that you wish to beaccommodated with you (continued )

�Additional proof needed for

Dependant Children• Child Benefit letter for all dependant childrenliving with you

• bank statement if benefit is paid directly into thebank

• Child Tax Credit letter

Non-dependants living at your address• Benefit letter•Wage slip

Continues on next page



Fifth personSurname Mr Mrs Ms Miss

First names




Sixth personSurname Mr Mrs Ms Miss

First names




Yes No

Name

Due Date

Yes No

Name

Address and

postcode

Reason

11 Is anyone listed in Question 10 pregnant?If ‘yes’, name the expectant mother

� Proof neededMat B1 (expected date of delivery certificate) orletter from doctor or midwife

12 Is anyone you are requesting to be re-housedwith you listed in Question 10 not living withyou now?

10 Details of people that you wish to beaccommodated with you (continued )�Additional proof needed for

Dependant Children• Birth certificate• Child Benefit letter for all dependant childrenliving with you

• bank statement if benefit is paid directly intothe bank

• Child Tax Credit letter

Non-dependants living at your address• Benefit letter• Wage slip

If necessary, please add any other people thatyou want to be accommodated with you onAdditional Information page 22 of this form



Local Connection

Applicant Yes No Partner Yes No

6 out of the last 12 months? Applicant Yes No Partner Yes No

or 3 out of the last 5 years? Applicant Yes No Partner Yes No


If your answer is ‘yes’ provide their name(s), address where they live and relationship to you below.



If your answer is ‘yes’ please provide more details below including where you were last based and the date you left.

13 Have you or your partner been a permanentresident of Oxford and lived here continuouslyfor at least 6 out of the last 12 months?

Have you or your partner previously been apermanent resident of Oxford and lived herecontinuously for at least:

Do you or your partner have close familyrelatives in Oxford that have lived herecontinuously for the last 5 years or more?

Do you or your partner work in Oxford for atleast 16 hours each week (answer ‘no’ to thisquestion if the work is of a short-term ortemporary nature)?

Are you or your partner a member, formermember or bereaved spouse/civil partner ofa member of the armed forces?

To qualify for inclusion on the Housing Register you will normally need to have a Local Connection toOxford through residence, work or close family (with some exceptions including members/formermembers of the Armed Forces – see the Allocations Scheme for more details)



Address 1 (current address) Postcode

Private Rented Owner Occupied Other Please State

Date moved in

Reason for leaving

Address 2 Postcode


Date moved in Date moved out

Reason for leaving

Address 3 Postcode



Reason for leaving

Address 4 Postcode



Reason for leaving

Address 5 Postcode



Reason for leaving

14 Local Connection; addresses for the lastfive years (if you and your partner have lived atseparate addresses please provide AdditionalInformation on page 22)Please list your most recent address first

� Proof needed for Address 1

Tenant(s): a copy of your tenancy agreement ora letter from your landlord confirming the date your tenancy started, the type of property andnumber of bedrooms you are renting and facilitiesyou have access to. Supply your landlord's contactdetails too.

Non-tenant(s): a letter from the person you areliving with stating the date you moved in and detailsof the number of bedrooms and facilities you haveaccess to and whether you have to share any them.

No Fixed Abode: you may not be considered apermanent resident of Oxford and to qualify forhousing. Supply letters from the people you arestaying with, stating how often you stay with themand whether you have access to a bedroom and/orother facilities when you stay. Also supply a letterstating what you are doing to try and findsomewhere to live. If you have attended a ‘tenantready scheme’ you should provide proof of this.Further information may also be required.

If necessary, please add any additional addresses onAdditional Information page 22 of this form



You do not have a secure tenancy and are worried about losing your home in the future

Present home is over crowded

Sharing property with people who will not be moving with you

Over 55 years old and interested in housing for older people

You have a health condition that is affected by your present housing

You have a disability affecting your mobility

You are experiencing emotional distress

You experience mental health problems

You have a learning disability

You are experiencing domestic abuse

You are experiencing harassment because of your race, religion, sexuality or any other reason

You are experiencing problems with neighbours

You are homeless or about to become homeless

You are a young person leaving the care of a local authority

You have a history of sleeping rough in the last 5 years

You are leaving or have left prison within the past 5 years

You misuse drugs or alcohol

Why do you need re-housing?

Please tick each box that applies to anyone listed inquestion 10

15 You are recovering from the misuse of drugs or alcohol

Your home has been subjected to vandalism or break ins

Your relationship with someone in your present home has broken down

You have difficulty meeting rent or mortgage payments on your present home

You want to move to be nearer your work or to take up employment

You want to move to be nearer to family (or other support) to give or receive support

You would benefit from extra support

Any other reason (please state what this is below)



Health and Disability

Yes No

Names

Details

A ground floor property with level access throughout? Yes No

A property with wide door ways and electric switches that have been placed to suit Yes No a disabled person?

A property with some adaptations (such as a level access shower, stair lift or walk-in bath)? Yes No

A purpose built or fully adapted property for someone who uses a wheelchair indoors? Yes No

Type of Property Flats and Floor Level

Self contained studio flat With a lift Without a lift

Flat Ground Floor Ground Floor

1st Floor 1st Floor

2nd Floor 2nd Floor

Above 2nd Floor Above 2nd Floor

Bungalow

Maisonette

House

16 Do you, or anyone named in question 10, havea health issue, that affects your mobility, that ismade worse by your current home?

If ‘yes’ please give details of how the healthissue could be improved by a move to a moresuitable property? The Council uses a separate procedure to take intoconsideration any health issues. The Housing NeedsTeam may contact you to request furtherinformation if required

Due to a health issue or disability does/or dothe person(s) listed above require one or moreof the following: (please tick yes or no)

17 If you have answered ‘yes’ to question 16Please tick all the property types you considerwould meet your housing requirements

If you have selected a ‘flat’ tick all the floorlevels you consider would be suitable

The Council will only allocate properties inaccordance with the Allocations Scheme, soalthough your preferences will be taken intoaccount where possible, some properties may notbe considered suitable for your household



Support Needs

Care or Support from Social Services Yes No Treatment for drug addiction Yes No

Treatment for a mental health condition Yes No Treatment for alcohol abuse Yes No

Further details

Yes No

Social Worker

Probation or Youth Offending Officer

Community Psychiatric Nurse

Support Worker or Keyworker

Health Visitor

Occupational Therapist

Anyone else who helps care for you?

18 Have you or anyone listed in question 10received any of the following in the last fiveyears (tick as many as apply)

If you answered ‘yes’ to any of these questions,please provide the name and further details aboutwho received this support or treatment

19 Do you or anyone listed in question 10 haveany involvement with any of the services listed?

If so please write their name, the agency to whichthey belong, and their phone number Name Agency T:



Yes No

Financial Circumstances

Yes No

Yes No

20 Tell us how the support worker helps and howregularly you receive this support

21 Do you feel you have support needs that arenot currently being met?

Please continue on page 22 if you would like toprovide additional information

22 Do you want to be considered for Low Cost‘Help to Buy’ Home Ownership Schemes as wellas rented social housing?

If ‘yes’ please also register with the ‘Help toBuy’ agent for Oxford. See the Council'swebsite or contact the Housing Needs Teamfor more information on how to do this

23 Does anyone listed in your household inquestion 10 have savings and/or investments(including property, stocks and shares)totalling £16,000 or more?

If ‘yes’ please state their name(s) and the total value

Applicants or adult members of their household may not qualify for inclusion on the Housing Registeror a Housing Application, regardless of their housing circumstances, if there is evidence to suggest thatthey have sufficient income or assets to resolve their housing situation through the housing market byrenting or buying a suitable home. See the Allocations Scheme for more details



Yes No

Name of household member(s)

Full address(es) of property/properties

Value of the property/properties

Applicant Yes No Do you normally work 16 hours or more a week Yes No

Name and address of employer

Postcode

More than one employer

Joint applicant Yes No Do you normally work 16 hours or more a week Yes No

Name and address of employer

Postcode

More than one employer

24 Do you, your partner or anyone named inquestion 10 own, or part own, a property inthe UK or another country?

If the answer is ‘yes’ supply the name of thehousehold member(s), full address and value of theproperty/properties

You may be asked for more details if you own aproperty (including proof of the amount of equityyou have in the property)

25 Are you or your partner employed in Oxford?

If yes, please give name and address of employer

If either of you have more than one employer,please give more details on the additional information page at the end of this form



ApplicantNet earned income weekly monthly

Name of Benefit Amount

weekly monthly

weekly monthly

weekly monthly

Do you have any Savings (including the balance in your current account)? Yes No

If ‘yes’, please state the total current balance of your savings:

Do you have any other investments in the UK or Overseas Yes No(including property, shares, stocks or bonds)

If ‘yes’, please state the current total value of the investments:

Joint applicantNet earned income weekly monthly

Name of Benefit Amount

weekly monthly

weekly monthly

weekly monthly

Do you have any Savings (including the balance in your current account)? Yes No

If ‘yes’, please state the total balance of your savings and current account(s):

Do you have any other investments in the UK or Overseas Yes No(including property, shares, stocks or bonds)

If ‘yes’, please state the current total value of the investments:

26 Earned income, benefits and savings

This information is required to determine yourhousing need for the housing register

This information may also be used whenconsidering applicants for shared ownershipproperties under ‘Help to Buy’ schemes

� Proof neededAny bank account statements (including currentaccount) benefit letter, wage slip, building societybooks or any documents relating to investmentssuch as share certificates may be required



Application and Tenancy History

Yes No

Name of person

Address applied from

Postcode Application reference

Name of person

Address applied from

Postcode Application reference

Yes No

Name of person

Address of tenancy

Postcode Details of tenancy

Name of person

Address of tenancy

Postcode Details of tenancy

27 Have you or anyone named in question 10 everapplied to Oxford City Council or one of itspartner registered providers for a homebefore?

If ‘yes’, please give the name(s) of the person(s),the address they applied from and any previousapplication reference numbers (if known)

28 Have you or anyone named in question 10ever had a tenancy with a Council, a HousingAssociation or a Registered Provider of socialhousing before?

If ‘yes’, please give the name of the person(s), theaddress of the tenancy, landlord of the property,and details of that tenancy (including why you leftand if you owe any outstanding rent arrearsand/or re-charges)

To qualify for inclusion on the Housing Register housing applicants need to be able to demonstrate thatthey are suitable to be potential tenants. If a housing applicant has rent arrears, former tenant rentarrears or they or a member of their household have been responsible for Anti-Social Behaviour theycan be excluded from inclusion on the Housing Register. See the Allocations Scheme for details.



Yes No

Details of action taken

Yes No

Details of convictions

Yes No

Details of employment or position held

Yes No

Give the name and details of who your relative(s) work for:

29 Have you or anyone named in question 10 everbeen taken to court for rent arrears, nuisance,any other tenancy breach, or for anti-socialbehaviour?

If yes, please give details including who took theaction against you, the reason why, the date of thisaction and any court decision

30 At the date of this application have you oranyone named in question 10 been convictedof a criminal offence? Under the terms of the Rehabilitation of OffendersAct 1974 you are entitled not to disclose anyconviction which is ‘spent’

If you are unsure about whether a conviction is‘spent’ you should consult a solicitor beforereturning this form

31 Are you or anyone named in question 10employed by Oxford City Council or by one ofits partner Registered Providers (see the backpage of the form)

If ‘yes’ give details

32 Are you or anyone named in question 10related to a member of staff, Councillor orcommittee member of Oxford City Council orits partners (see the back page)?

If ‘yes’ give details



Details about Your Current Accommodation

Yes No

Details of fault or disrepair

Do you (and your household) have sole use of the property where you live? Yes No

Do you (and your household) share a property with another person or household? Yes No

Other, please specify

Lodger

Living with relatives or friends

Short term license/hostel

Private tenant

Tenant of another Council or a Housing Association

not listed on this form as a partner organisation

Shared ownership tenant/part owner

Yes No

Date of termination

33 Does the property you live in have anysignificant faults, or is it in disrepair?

If ‘yes’ contact your landlord to discuss the issues.If you are unsuccessful in resolving the problems,contact the Environmental Development Team onT: 01865 249811

34 Please describe the type of accommodationwhere you currently livePlease tick one box

35 Please describe your security of tenure whereyou currently live

Please tick one box

36 Are you living in tied accommodation?

Please give the date that your employmentterminates or terminated

� Proof neededLetter from employer, employers notice to quit

15

Owner Occupier

Home provided with job

Living in a ‘Move On’ Homeless Project in Oxford

No Fixed Abode/ Homeless

Squatting



Housing Application for Inclusion on the General Register List16

Flat Maisonette House Bungalow (tick one box)

Ground 1st floor 2nd floor (or above)

Is there a lift in the property? Yes No

If ‘yes’ does the lift go to the floor you live on? Yes No

Caravan, Mobile Home, Houseboat Hostel Hospital Prison


Number of bedrooms

Bedroom Number of people If you consider the room too small using the bedroom please give the size of the room

1

2

3

4

5

Name of owner

Property address

Postcode

Yes No

Yes No

37 What is your current property type?

If you live in a flat, maisonette, or a room in ashared property, please state what floor you live on:

38 How many bedrooms are available to be usedby the people listed in question 10

Please give details of the bedrooms used by thepeople on your application:

39 Please provide the name and address of yourcurrent landlord, owner of property, orhousing provider

Do you owe any rent or re-charges to yourlandlord?

If ‘yes’ please provide details and state how muchyou owe?

40 Are you at risk of being homeless?



Yes No

Leaving date

Yes No

Name of household member(s)

Property address

Postcode

Description, tenure status, current situation

Yes No Date of hearing

Yes No Date of eviction

Yes No

Date of discharge

41 Have you been given written notice to leaveyour current accommodation?

If ‘yes’, please give details and the date you weretold to leave by

� Proof neededA copy of any written notice

43 Has there been a possession order issued froma Court?

If ‘yes’, has the the Court issued an EvictionWarrant?

Please give the date of the hearing, and the date ofthe eviction notice if one has been served

� Proof neededA copy of any Court Order(s) issued

44 Are you a member of Her Majesty’s ArmedForces?

If ‘yes’, please give your discharge date and providea copy of the discharge letter.

42 Do you, or anyone named in question 10, have a lease or tenancy of a residentialproperty, here in the UK or overseas otherthan the application address?

If ‘yes’, please give details and reasons why you/or they are not presently living at this property



Facility Available in the place you are living Shared with people not on your application

Kitchen or cooking facilities Yes No Yes No

Inside toilet Yes No Yes No

Fixed bath or shower Yes No Yes No

Living room Yes No Yes No

Hot water supply Yes No Yes No

Fixed Heating System Yes No Yes No

Yes No

Many properties are unsuitable for pets. By requesting you are re-housed with your pet, you will significantlyrestrict the types of property you can be considered for.

Sheltered Housing

This housing is usually let to people aged 60 or over who have an identifiable support need following a needs assessment. Some properties have an age criteria of 55+ for people who would benefit from the support provided.Sheltered Housing may have a community alarm, visiting support staff and usually has shared facilities such as a laundry and common room.

Yes No

45 Which of the following facilities are availablein the place you are living and are they sharedwith people not on your application?

If you have answered ‘no’ to having any of thefacilities listed please provide more details

46 Do you or anyone listed in question 10 have apet you want to be re-housed with you?

Please provide details (including type and number)

.

47 Accommodation for older people

Please contact the Housing Needs Team for moreinformation about this type of accommodation

If you are aged 55 years or older please state ifyou are interested in being considered forsheltered housing:

18



What Next?

Signed the declaration overleaf

Completed the equal opportunities form

Provided all the documents of proof in support of you application

Thank you.Please take the form back to one of the offices listed on the front of this form where staff will copy and verify your original documents and return them to youduring your visit. Please phone 01865 249811 to book an appointment

48 Further InformationPlease use this space to give reasons why youcannot live in a certain area or if there is a reasonwhy you need to move urgently which we have notasked about elsewhere on this form (e.g. if you havebeen the victim of domestic abuse)

49 Other Information

Please use this section to give details of anythingelse you would like to be considered that has notbeen covered fully elsewhere in the form

50 Check you have:

19



Declaration

I confirm that I/we have read, or have been read, the declaration above and I/we understand the information it contains and my obligations

Applicant

Date

Joint Applicant

Date

All applicants and joint applicants mustread this declaration and sign below

Signatures

20

� I certify that all the details given on this application,are to the best of my knowledge, true and correct.

� I undertake to immediately notify Oxford CityCouncil’s Housing Needs Team,by calling HousingNeeds on 01865 249811, of any changes to thedetails I have provided.

� I understand that in the event of any details beingfound to be untrue or inaccurate, or if I haveneglected to tell the Council of any changes in mycircumstances, this application will be cancelled, andI may be liable to prosecution, which could lead to acriminal conviction, a fine up to £5,000, and/or a termof imprisonment. In addition, legal proceedings maybe taken to repossess any property offered to me.

� I understand that Oxford City Council will hold theinformation I have provided securely and under theprovisions of the Data Protection Act 1998.

� I understand that Oxford City Council is under a dutyto protect public funds and may use the informationI have provided and match it against otherinformation held by the Council and other publicbodies, or similar external agencies, for the purposeof the prevention or detection of crime and fraud,

and to verify the information I have provided.For further information, see http://occweb/websitetools/privacy.cfm

� I consent to Oxford City Council and partnerassociations listed on the back of this form, makingsuch enquires as is considered necessary in order toassess this application, and I authorise all otherdepartments, organisations and agencies to providesuch information as is requested.

� I consent to references being obtained from previouslandlords of the properties I have lived in during thelast five years.

� I authorise Oxford City Council and partnerassociations listed on the back of this form, to shareinformation on this application between themselves,with other statutory and voluntary agencies,including other housing providers, health trusts,support providers, police, probation, social servicesand other local authorities, where deemed necessary,and/ or to provide me with advice or assistanceregarding my rehousing, or other services that mayassist me. I understand that the Council and partnerassociations will not give information about me toanyone else, unless I provide written authorisation forthem to do so.



Name Signature Date

Reason

Name & address of organisation

Postcode

Name of contact Yes No

From time to time Oxford City Council and partner asociations listed on the back of this form will send you information you may find useful. We may also send out customer surveys. Please tick here if you do not require this information

If you are willing to be contacted more often about how Oxford City Council and the partner associations might improve and develop their services, please tick here

Proxy declaration

Please complete this section if you havecompleted the form for somebody else.By signing this section you are certifying thatyou have gone through all the informationwith the applicant and the applicant agreesthat this is correct

Are you being advised by an advice centre oragency?

Do you agree for this organisation to becontacted regarding this application and thedetails in it?

21



Additional information

22



Office Use OnlyDate Stamp Application number

How would you describe your ethnic origin?


White

British

Irish

Gypsy or Irish Traveller

Any other White

background please specify

Mixed White and Black

White & Black Caribbean

White & Black African

White & Asian

Any other mixed


Oxford City Council is committed to understanding its customers andproviding fair and accessible services.

In order to ensure that housing services are provided on a fair and equal basisto everyone, we record and monitor the ethnic group of persons applying tothe Council for housing. By providing the information below, you help us todo this. This information is not used to assess or prioritise your applicationand is treated in confidence.


Asian, or Asian British

Chinese

Indian

Pakistani

Bangladeshi

Any other Asian


Black / African / Caribbean / Black British

Caribbean

African

Any other Black


Other ethnic group

Arab

Any other ethnic


I choose not to answer

this question

Equal Opportunities Valuing Diversity Form

The Oxford Register for Affordable Housing is a partnership between Oxford City Council and the registered providers listed below

A2Dominion

Bromford Group

Catalyst Housing Group

GreenSquare Group

Home Group

Jephson Housing Association Group

Soha Housing

Thames Valley Housing

Sovereign Vale

Contact us

Oxford City Council Housing Needs Team

T: 01865 249811

St Aldate's Chambers, 109–113 St Aldate's,

Oxford OX1 1DS


December 2014

oxford city council - general housing register form · housing needs oxford city council ....

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