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
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
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
OXFORD REGISTER FOR AFFORDABLE HOUSING
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
OXFORD REGISTER FOR AFFORDABLE HOUSING
Housing Application for Inclusion on the General Register List
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
OXFORD REGISTER FOR AFFORDABLE HOUSING
Housing Application for Inclusion on the General Register List
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
OXFORD REGISTER FOR AFFORDABLE HOUSING
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
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
OXFORD REGISTER FOR AFFORDABLE HOUSING
2 Housing Application for Inclusion on the General Register List
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?
OXFORD REGISTER FOR AFFORDABLE HOUSING
3 Housing Application for Inclusion on the General Register List
Joint 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
Second personSurname Mr Mrs Ms Miss
First names
Date of birth (dd/mm/yyyy) Male Female
Relationship to applicant
NI No. In paid employment? Yes No
Third personSurname Mr Mrs Ms Miss
First names
Date of birth (dd/mm/yyyy) Male Female
Relationship to applicant
NI No. In paid employment? Yes No
Fourth personSurname Mr Mrs Ms Miss
First names
Date of birth (dd/mm/yyyy) Male Female
Relationship to applicant
NI No. In paid employment? Yes No
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
OXFORD REGISTER FOR AFFORDABLE HOUSING
4 Housing Application for Inclusion on the General Register List
Fifth personSurname Mr Mrs Ms Miss
First names
Date of birth (dd/mm/yyyy) Male Female
Relationship to applicant
NI No. In paid employment? Yes No
Sixth personSurname Mr Mrs Ms Miss
First names
Date of birth (dd/mm/yyyy) Male Female
Relationship to applicant
NI No. In paid employment? Yes No
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
OXFORD REGISTER FOR AFFORDABLE HOUSING
5 Housing Application for Inclusion on the General Register List
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
Applicant Yes No Partner Yes No
If your answer is ‘yes’ provide their name(s), address where they live and relationship to you below.
Applicant Yes No Partner Yes No
Applicant Yes No Partner Yes No
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)
OXFORD REGISTER FOR AFFORDABLE HOUSING
6 Housing Application for Inclusion on the General Register List
Address 1 (current address) Postcode
Private Rented Owner Occupied Other Please State
Date moved in
Reason for leaving
Address 2 Postcode
Private Rented Owner Occupied Other Please State
Date moved in Date moved out
Reason for leaving
Address 3 Postcode
Private Rented Owner Occupied Other Please State
Date moved in Date moved out
Reason for leaving
Address 4 Postcode
Private Rented Owner Occupied Other Please State
Date moved in Date moved out
Reason for leaving
Address 5 Postcode
Private Rented Owner Occupied Other Please State
Date moved in Date moved out
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
OXFORD REGISTER FOR AFFORDABLE HOUSING
7 Housing Application for Inclusion on the General Register List
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)
OXFORD REGISTER FOR AFFORDABLE HOUSING
8 Housing Application for Inclusion on the General Register List
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
OXFORD REGISTER FOR AFFORDABLE HOUSING
9 Housing Application for Inclusion on the General Register List
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:
OXFORD REGISTER FOR AFFORDABLE HOUSING
10 Housing Application for Inclusion on the General Register List
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
OXFORD REGISTER FOR AFFORDABLE HOUSING
11 Housing Application for Inclusion on the General Register List
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
OXFORD REGISTER FOR AFFORDABLE HOUSING
12 Housing Application for Inclusion on the General Register List
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
OXFORD REGISTER FOR AFFORDABLE HOUSING
13 Housing Application for Inclusion on the General Register List
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.
OXFORD REGISTER FOR AFFORDABLE HOUSING
14 Housing Application for Inclusion on the General Register List
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
OXFORD REGISTER FOR AFFORDABLE HOUSING
Housing Application for Inclusion on the General Register List
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
Other, please specify
OXFORD REGISTER FOR AFFORDABLE HOUSING
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
Other, please specify
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?
OXFORD REGISTER FOR AFFORDABLE HOUSING
Housing Application for Inclusion on the General Register List17
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
OXFORD REGISTER FOR AFFORDABLE HOUSING
Housing Application for Inclusion on the General Register List
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:
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OXFORD REGISTER FOR AFFORDABLE HOUSING
Housing Application for Inclusion on the General Register List
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:
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OXFORD REGISTER FOR AFFORDABLE HOUSING
Housing Application for Inclusion on the General Register List
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.
OXFORD REGISTER FOR AFFORDABLE HOUSING
Housing Application for Inclusion on the General Register List
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?
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OXFORD REGISTER FOR AFFORDABLE HOUSING
Housing Application for Inclusion on the General Register List
Additional information
22
OXFORD REGISTER FOR AFFORDABLE HOUSING
Housing Application for Inclusion on the General Register List23
Office Use OnlyDate Stamp Application number
How would you describe your ethnic origin?
Applicant Joint Applicant
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
background please specify
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.
Applicant Joint Applicant
Asian, or Asian British
Chinese
Indian
Pakistani
Bangladeshi
Any other Asian
background please specify
Black / African / Caribbean / Black British
Caribbean
African
Any other Black
background please specify
Other ethnic group
Arab
Any other ethnic
background please specify
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
OXFORD REGISTER FOR AFFORDABLE HOUSING
December 2014