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The following information will be used in assessing your application. It will be kept confidential to those within the Charity responsible for considering your application.Applicants will normally be 65 years of age or over. In the case of joint applicationsat least one applicant must be aged 65 years or over.Applicants are advised that failure to disclose any relevant information mayprejudice their application. Misleading or inaccurate information may lead to yourappointment being set aside at some time in the future and your having to leave thealmshouse.PART 1:Personal informationA: Primary applicant Name _______________________________________ Address __________________________ ___________________________________________________ Postcode ___________________ Previous address [if less than 5 years at current address] ________________________________________________________________________________ ____________________________________________________ Postcode __________________ Telephone No. ____________________________ Mobile No. ___________________________ Date of Birth ____/_____/______ Age ______ Place of Birth __________________________ Years lived in Colchester __________ Other connections with Colchester: _________________________________________________________________________________

_________________________________________________________________________________________________

Occupation ______________________________ Current Past

Hours a week ______ Employer _______________________________________________________________________ B: Secondary Applicant Relationship to Primary Applicant:Partner Son/Daughter Other Please specify _____________________________ Name _______________________________________ Address __________________________

Winsleys Charity22 Winsley SquareColchester CO1 2AU01206 794064

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Application Form

Winsleys Charity (Registered Charity No. 206000)

___________________________________________________ Postcode ___________________ Previous address [if less than 5 years at current address] ________________________________________________________________________________ ___________________________________________________ Postcode __________________ Telephone No. ____________________________ Mobile No. ___________________________ Date of Birth ____/_____/______ Age ______ Place of Birth __________________________ Years lived in Colchester __________ Other connections with Colchester: _________________________________________________________________________________

_________________________________________________________________________________________________

Occupation ______________________________ Current Past

Hours a week ______ Employer _______________________________________________________________________

PART 2:Current housingA: Whom you live with nowWho lives with you at your current address other than the secondaryapplicant? (i.e. people who will NOT be moving with you to Winsleys)

_________________________________________________________________________________________________

_________________________________________________________________________________ Where will they live if you move to Winsleys? _____________________________________

_________________________________________________________________________________________________

(Note: Properties at Winsleys are suitable for single or couple occupation.)

Winsleys Charity22 Winsley SquareColchester CO1 2AU01206 794064

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Application Form

Winsleys Charity (Registered Charity No. 206000)

B: Type of property you live in nowFlat Maisonette House Bungalow Hostel OtherIf other, please specify __________________________________________________________ If you don’t live on the ground-floor, which floor do you live on? ____________________ Do you share any of these facilities with another household (i.e. people other thanthe second applicant) Bath/shower Kitchen LoungeC: Type of resident currently Do you own your current home? Yes Go to Section DAre you a tenant? Yes Go to Section EAre you a lodger? Yes Go to Section E & FHave you ever owned a property? Yes Go to Section GD: Owning your HomeWhat is the current estimate of the value of your property? £______________________ Do you own the property outright or is there an outstanding mortgage?Owned outright Mortgage Mortgage capital outstanding £________________ Years remaining on mortgage _____________ Any arrears? How much? _________ If in arrears, has Court action been taken against you? (please attach evidence)Freehold Leasehold Lease remaining in years ___________ What are your intentions regarding this property if you are offered an Almshouse? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________

Winsleys Charity22 Winsley SquareColchester CO1 2AU01206 794064

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Application Form

Winsleys Charity (Registered Charity No. 206000)