National Insurance Number Checker

National Insurance Check

Eligibility Part 1
Eligibility
Thank you for approaching Wiltshire Council for housing.

Please note that in making a housing application, you are asking Wiltshire Council to assess –

l Your eligibility for housing in the UK

l Whether you have a housing need under the council’s Housing Allocation Policy and
l Whether there are any reasons under our policy that we could not consider you for an allocation of housing eg lack of
connection to the area and housing debts

You must answer all the questions that apply to you in full, honestly and truthfully as this is a legal document and seeking to
obtain social housing by lying about your circumstances is a criminal offence. The council takes housing fraud seriously and
possession proceedings will be commenced against any tenant found to have obtained a tenancy by fraud.

Please note that we consider whether applicants can meet their own housing need in the marketplace in light of their assets
(capital and/or property) and/or income. Please see About Homes4Wiltshire on the website for further details of our financial
resource limit.

In the section ‘Reasons for seeking alternative accommodation’, please state fully your reasons for seeking a move and why
your present home is not suitable for you.

In making a housing application, you are sharing more information about your personal circumstances with Wiltshire Council.

Wiltshire Council will look after your information, keep it secure, and process it in compliance with all current data protection
legislation including the Data Protection Act and the General Data Protection Regulation. Please see the Data Protection page
under About Homes4Wiltshire for further information.

Please note that Wiltshire Council has an information sharing protocol with other statutory bodies and agencies including
housing providers to ensure that we work together effectively in the service of our communities, for example in relation to the
meeting of care needs, and the prevention of crime and anti-social behaviour.

Important note: Deliberately providing false information for the purpose of obtaining a social rented home is a criminal
offence

To apply to join the Housing Register you must be 16 years of age or over. To join, you must meet the qualification criteria.

You are likely to qualify if you meet the following requirements:

l you must be aged 16 or over and not subject to immigration rules meaning that you cannot be considered for social
housing in the UK
l you currently reside in the Wiltshire Council area and have done so for the past 2 years, or
l are in permanent paid employment or have a fixed term contract for a minimum of one year, or have an offer of permanent
paid employment or self employed and work predominately in the Wiltshire Council area, or
l have close family (grand-parents, parents, legal guardians, adult children or brothers and sisters) who have continuously
lived in Wiltshire Council’s area for 5 years or longer, or
l have a connection to Wiltshire Council’s area through special circumstances, such as a need to receive specialist
medical services, support from a close family member or access services within the county which cannot be provided
elsewhere or
l you are considered as an applicant from our local connection exclusion group (e.g some armed forces applicants)
l capable of living independently and, if requiring care and/or support to have an independent home, to be receiving care
and support

Please note that

l applicants aged 16 and 17 need a responsible adult to hold a tenancy in trust until the applicants reach the age of 18
l care leavers aged 17-21 need to have been assessed as ready to move into independent living accommodation by both
Children's services and the Housing Department

You will not qualify if you:-

l do not have a connection to the Wiltshire Council area and are not a category of person exempt from needing a
connection
l could meet your own housing need in the marketplace in light of your assets (capital and/or property) and/or income.
¡ Please see About Homes4Wiltshire on the website for further details of our financial resource limit
l own your own home and have no housing need, except where you are only seeking Extra Care Housing, supported or
sheltered housing with the council
¡ Please note that some housing providers may not consider those with assets or income above a certain level
unless there are exceptional circumstances
l are serving a prison sentence and do not have a discharge date within the next 28 days
l are guilty of unacceptable behaviour serious enough to make you unsuitable as a prospective tenant (applies to all
members of your household)
l have housing debts and not maintained a repayment plan for 6 months or repaid more than half the debt and are
continuing to make repayments
l have been housed within the last 12 months and have no change in circumstances

So we can assess your housing application, please provide documents showing that you are eligible for housing in the UK
and in housing need (please see ‘How Homes4Wiltshire Works' page of the website. People who are not, by law, eligible to
join the Housing Register are:

l certain people who are subject to Immigration Control

l certain people from abroad who are not subject to immigration control but who are not habitually resident in the UK, the
Channel Islands, the Isle of Man or the Republic of Ireland
l those with leave to enter the UK but subject to a condition of no recourse to public funds
l people (including members of the applicant’s household) who have been guilty of unacceptable behaviour in the past
year that makes them unsuitable to be a tenant.

For more detailed information please see the council’s Allocation Policy or speak to the Homes4Wiltshire team.

Please confirm you have read and understood the above criteria and are eligible to join the register*
No

Eligibility Part 2
Local Connection
To join the Housing Register, you need to have a connection to the Wiltshire Council area or be a category of person which
does not require a connection.

Do you have a local connection to the Wiltshire Council area?*

Yes

If yes please confirm your connection by selecting the appropriate box(es) below:-

Are you currently a resident living in the Wiltshire Council area and have continuously lived in the area for the past two
years*
Yes

Do you have permanent paid employment or have a fixed term contract for a minimum of one year in the Wiltshire Council
area*
Yes

Do you have an offer of paid employment for a minimum period of 12 months in the Wiltshire Council area*
No

Are you self-employed and work predominately in the Wiltshire Council area*
No

Do you have close family (grand-parents, parents, legal guardian, adult children, brothers or sisters or another relative or
person who has fulfilled the responsibility of parent in the absence of either parent*) who have continuously lived in the
Wiltshire Council area for 5 years or longer*
Yes

* another relative or person must be someone who has performed the function of a parent for a significant part of your
childhood in the absence of either parent or any other person who was performing the role of parent eg a private foster parent

Do you have a connection with the Wiltshire Council area through special circumstances, such as a need to receive
specialist medical services, services within the county which cannot be provided elsewhere or support from a close family
member*
No

If you have indicated there are special circumstances, please provide details
not entered

If the answer is No, are you considered to be someone from the exclusion group? Please tick the appropriate box(es)
below

No

Exclusion Group members are:

A person who is homeless within the meaning of Part 7, Housing Act 1996 to whom Wiltshire Council has accepted a full
re-housing duty under Section 193(2) or Section 195(2) of the act *
No

A person to whom the full re-housing duty is owed where s/he is a homeless applicant re-applying after a private rented
sector offer under S195A(1) of the above Act, regardless of whether the applicant has a priority need and where (a) the
person makes a re-application for assistance within two years of accepting a private rented sector offer, and(b) is eligible
for assistance and has become homeless unintentionally *
No

A person who was provided with accommodation in the County of Wiltshire under section 95 of the Immigration and
Asylum Act 1999*
No

A person who is serving in the Armed Forces*

No
A person who has left the Armed Forces within the last 5 years*
No

Any veteran who can demonstrate a connection to Wiltshire as well as serving a minimum of three years and who has not
been dishonourably discharged*
No

A bereaved spouse or civil partners of members of the Armed Forces leaving services family accommodation following the
death of their spouse or partner*
No

A separated or divorced spouse who is being asked to leave services family accommodation in the Wiltshire area, *
No

Serving or former members of the Reserve Forces who need to move because of a serious injury, medical condition or
disability sustained as a result of their service*
No

A person who is being accommodated through an official witness protection scheme authorised by the Home Office *
No

A person who has been confirmed as having suffered domestic abuse and who needs to move to the Wiltshire Council
area or from one part of Wiltshire Council’s area to another to ensure his/her safety or a person who has suffered any
other violent assault or threat of violence making his/her home unreasonable to occupy under Part 7, Housing Act 1996*
No

A person from the transient community or a household leaving armed forces accommodation who does not have a
connection to another Local Authority area which would confer upon her/him the right to join that Local Authority’s Housing
Register*
No

A person who has been accommodated outside the area by Wiltshire Council in exercising its statutory duty to
accommodate*
No

A person with a connection to an adjoining parish that is outside of Wiltshire Council’s area but whose housing need has
been used to develop affordable housing within a parish in the Wiltshire Council area. These households will only be
allowed to bid for properties within the parish identified to meet their housing need*
No

A person who has been verified as a rough sleeper, where there is proof of rough sleeping in the Wiltshire Council area,
where the person has no connection with another Local Authority area as defined by S199 Housing Act 1996*
No

A person assessed as having an exceptional medical need to move under Band One *
No

Eligibility Part 3
Current Circumstances
Have you been allocated a social tenancy in the last 12 months?*
No

If you have been allocated a social tenancy in the last twelve months, have your household circumstances changed since you
moved?
not selected

Please provide details of your change of circumstances

not entered

Are you currently in prison?*

No

Do you have a discharge date in the next 28 days?

No

Anti-social Behaviour
The behaviours referred to include, but are not limited to –

l Recorded anti-social behaviour in the last 12 months where the applicant was issued with a formal warning, an
acceptable behaviour contract or an order made under the anti-social behaviour legislation
l Other behaviour in the last 12 months where the applicant or a member of his or her household has caused a nuisance
or annoyance by which has affected neighbours or members of the local community in which s/he lives or has lived
l Incidents of domestic abuse, harassment on grounds of race, ethnicity, gender, age, disability, religion, gender identity or
sexual orientation, any threats of and/or actual violence to people or damage to property or any activity potentially
threatening the community will be considered unacceptable behaviour.
 Possession proceedings or other legal action taken or pending by a professional agency or landlord in direct
consequence of anti-social behaviour will be taken to constitute evidence. Legal action includes, but is not limited to,
formal action under the anti-social behaviour legislation and the service of notice on the ground of anti-social behaviour.
Convictions, cautions and bind overs for offences likely to make someone unsuitable to be a tenant will be considered as
evidence too.

Have you been responsible for anti-social behaviour or other unacceptable behaviour serious enough to make you
unsuitable as a prospective tenant in the past 12 months (includes behaviour by any member of your household) *
No

If you have been evicted or legal action taken, please provide details
not entered

Eligibility Part 4
About filling in this form
We need to receive documents supporting the statements made in your housing application.

It is essential that you submit the required documents to support your application for housing. If Homes4Wiltshire does not
receive all the necessary documents, we will not be able to assess your housing application. If you have scanning facilities, or
a digital camera, please email the documents to us at homes4wiltshire@wiltshire.gov.uk. Whilst electronic copies are
acceptable, Homes4Wiltshire or a housing provider may ask for originals later on as part of a verification and fraud prevention
process.

Please note that success at bidding relies upon parish connections, with bids for advertised homes from applicants with
connections to the parishes in which homes are located being ranked more highly than those without connections. We ask a
random sample of housing applicants to supply evidence of their parish connections.

Once you have completed your housing application form and sent in the information that we have requested we will assess
your housing need. We aim to do this within 28 working days of receipt of all the documents required. It may take longer if your
case is complex and we have to ask you further questions.

For Wiltshire Council tenants applying to transfer

We do not require any documents as we are able to undertake the necessary checks through our own systems unless you
have capital of £16,000 or above or need to move for medical or welfare reasons or to gain greater independence eg your
present home cannot be adapted to meet your physical needs.

l If you have more than £16,000 in capital, we will need a copy of your most recent bank or building society statement.
l If you need to move for medical or welfare reasons, we may need to contact medical or social care professionals about
the need for a move unless you have documents available eg letters from clinicians or social workers.
l If your home cannot be adapted, an Occupational Therapy Housing Report will be required (please see the website for
more information about how to obtain a report).

The documents we need are -

Eligibility for housing in the UK

Some people from abroad are ineligible for housing so we check eligibility for housing.

l UK and ROI nationals – a birth certificate or current passport

¡ Where not your own children we require an adoption/residence/guardianship order or a fostering agreement will be
required
l EEA nationals (Except Croatian Nationals) – a current passport, country ID card or similar document
l Croatian Nationals – a Blue worker Registration Certificate, Purple Accession Worker Card or yellow Student Registration
Card
l Nationals of other countries and Refugees – a current passport or Home Office Leave to Remain letter

Residency or association with the Wiltshire Council area

A connection to Wiltshire Council’s area is needed to join our register.

Please note that if you have been paying Council Tax in the Wiltshire Council area or have been registered to vote on the
Wiltshire Council Electoral Register for 2 years or more continuously we will not require evidence of connection to the
Wiltshire Council area.

For Residency
If you have lived in the Wiltshire Council Area continuously for 2 years and liable for Council Tax or registered to vote, we can
confirm your connection through the Council Tax and electoral registration records.
If not, please provide

l A copy of a bank/building society statement, utility bill, tenancy agreement or other document showing your name and
address from the last 3 months, and
l A similar document from between 2 and 3 years ago

For Working in the Wiltshire Council area

Please provide either

l A copy of your contract of employment* or

l A letter from your employer confirming your employment* or
l Payslips if these show the place of work or

If self-employed -
l A document with details of the partnership, company or, if trading on your own, registration for income tax self-
assessment or, if not self-assessed, Class 2 National Insurance contributions

* work includes unpaid internships and regular voluntary work (16 hours+ each week)

For Close family members (parents, legal guardians, grandparents, adult siblings and adult children)
 All relevant long birth certificates for parents and 3 generations' birth certificates will be required for grandparents .Where
names have changed, copies of the relevant marriage/civil partnership certificates, deed polls or court orders and
A utility bill, Council Tax bill, bank statement, photo licence or similar document. These will be required from both 5 to 6 years
ago and within the last 3 months, with documents for each address where the relative(s) concerned have changed address
Guardianship cases
For legal guardians, we will also need a copy of the court order granting guardianship
Adopted children
For adopted children, if a new birth certificate with the adoptive parent(s)'s name(s) is not available, we will also need a copy
of the adoption order in favour of the adoptive parents.

Connection based on special circumstances

If you do not have a connection by means of one of the above criteria, we may consider you to have a connection if you have a
special reason to be in Wiltshire Council’s area eg a need to receive specialist medical services, support from a close family
member or use services which are not available or cannot be provided elsewhere.
Please state on your housing application the reason for needing to move to WiltshireCouncil’s area. If you have any
documents in your possession which demonstrate the need to move to or remain in Wiltshire Council’s area, please provide
these. If not, pleasedon’t request a new letter from a health or social care professional. We can contact them for further
information. In making a housing application, you consent to the necessary exchange of information to assess whether
special circumstances apply.
Important note: Success at bidding through the Homes4Wiltshire choice based lettings scheme is based on parish
connections. A parish connection is either residency in the parish where you live for 12 months or more, employment in a
parish or the residency of a close family member as above in the parish where s/he lives for 5 years or more. If you bid for a
property in a parish where you have a connection, you are placed more highly in the ranking of bids for that property than if you
do not have a connection to that parish. We may use the above documents to evidence parish connections. If you state you
have other parish connections, Homes4Wiltshire will carry out random checks where an applicant has claimed a parish
connection through close family members to confirm these connections.

Excluded from needing a connection to Wiltshire Council’s area

Some groups of housing applicant are excluded from needing a connection to the Wiltshire Council area, including some
people who are or have been in the UK armed forces and reserve forces, some people escaping domestic abuse and verified
rough sleepers. More details of who qualifies for not needing a connection may be found in our Allocation Policy Please click
here.
If you believe you are in an exclusion group, please state this on the housing application form and we will seek further
information once we commence the housing needs assessment. In the case of current or former armed forces or reserve
forces personnel, please provide some written evidence for us to consider eg

l Discharge from Armed Forces

l Proof of posting/drafting

If you are escaping domestic abuse or sleeping rough, please contact our Housing Options team. Please click here Contact
Us.
Dependent children
If you have dependent children, we need to confirm that your home is your child/children’s main residence and that they are
dependent on you. Please supply either
Your Child Benefit Award letter for the current or previous tax year showing your name and address and your childrens’ name
Or
a complete bank or building society statement from the last 3 months showing your name and address and the Child Benefit
payment

PLEASE NOTE that it is your responsibility to submit documents to help us to assess your application. We will not
automatically write to you to request documents. Please submit documents within 28 days. If we receive some
documents but require more to assess your application, we will write to you.

IMPORTANT - What you write on this form will help us to assess your application to join the register.

You must answer all of the questions that apply to you in full, honestly and truthfully as this is a legal document.

When you reach the end of this online form you will be required to declare that the information you have entered is accurate.

About you - Main applicant

Main Applicant

Primary household member details

Applicant Details

Title*
Mr

First name*
Christopher Daniel

Family name*
Mason

Have you ever been known by any other name?*

No
If yes, please provide what names you have previously used
not entered

Home telephone*
07706189598

Work telephone
not entered

Mobile telephone
07706189598

E-mail address*
email.chris.mason@gmx.com

National Insurance Number*

JR328877B

Date of birth*
24/05/1984

Gender*
Male

Ethnic Origin*
White - English / Welsh / Scottish / Northern Irish / British

Ethnic Origin Details

English

Please select which applies to your nationality*

UK national

If EEA National, please select which country are you from

not selected

Pregnant?*
No

If yes, then when is the baby due

not entered

Current Address Details

Current Address
16 Ludlow Close Westbury Wiltshire BA13 3TQ
Date you moved in to this address:01/09/2010

Landlord Details
Sharon Rossiter

Correspondence Address
Correspondence description:Not Set
16 Ludlow Close Westbury Wiltshire BA13 3TQ

About you - Joint applicant

Household members

Joint household member details

Applicant Details
Title*
Miss

First name*
Laura

Family name*
Elvin

Have you ever been known by any other name?*

Yes

If yes, please provide what names you have previously used

Sarson

Address the same as primary applicant?*

Yes

Home telephone*
07749911463

Work telephone
not entered

Mobile telephone
07749911463

E-mail Address
laura.elvin1986@gmail.com

National Insurance Number*

JM239358C

Date of birth*
28/03/1986

Gender*
Female

Ethnic Origin*
White - English / Welsh / Scottish / Northern Irish / British

Ethnic Origin Details

English

Please select which applies to your nationality

EEA National (European Economic Area)

If EEA National, please select which country are you from?

not selected

Relationship to main applicant*

Spouse/Partner

Pregnant?*
No

If yes, when is the baby due

not entered

Current Address Details

Current Address
16 Ludlow Close Westbury Wiltshire BA13 3TQ
Date you moved in to this address:01/09/2010

Landlord Details
Sharon Rossiter

Additional household member details

Household Member Details
Title*
Miss

First name*
Elysia

Family name*
Mason

Is their address the same as the main applicant?*

Yes

Home telephone
not entered

Work telephone
not entered
Mobile telephone
not entered

E-mail Address
not entered

National Insurance Number

not entered

Date of birth*
17/03/2010

Gender*
Female

Ethnic Origin*
White - English / Welsh / Scottish / Northern Irish / British

Ethnic Origin Details

English

Relationship to main applicant*

Daughter

Pregnant?*
No

If yes, when is the baby due

not entered

If they do not live with you, how often do they stay with you?
not entered

Adopted or fostered - please tick if applicable*

No

Current Address Details

Current Address
16 Ludlow Close Westbury Wiltshire BA13 3TQ
Date you moved in to this address:01/09/2010

Landlord Details
Sharon Rossiter

Additional household member details

Household Member Details

Title*
Mr

First name*
Oscar

Family name*
Mason

Is their address the same as the main applicant?*

Yes

Home telephone
not entered

Work telephone
not entered

Mobile telephone
not entered

E-mail Address
not entered

National Insurance Number

not entered

Date of birth*
14/09/2014

Gender*
Male
Ethnic Origin*
White - English / Welsh / Scottish / Northern Irish / British

Ethnic Origin Details

English

Relationship to main applicant*

Son

Pregnant?*
No

If yes, when is the baby due

not entered

If they do not live with you, how often do they stay with you?
not entered

Adopted or fostered - please tick if applicable*

No

Current Address Details

Current Address
16 Ludlow Close Westbury Wiltshire BA13 3TQ
Date you moved in to this address:14/09/2014

Landlord Details
Sharon Rossiter

About your household

Guidance notes
" This section and the following section are designed to elicit as much information about your housing circumstances as
possible. Please give full details at each stage."

Household information

Have you or your partner been confirmed by the council’s Children’s Services Department or similar agency as suitable to
foster or adopt a child or children and awaiting the placement of a child?*
No

Any person in the household getting support from social services, a deputy managing her/his affairs, mental health
services, the probation service or any other body at the moment?*
Yes

Who gets support

Oscar

Name of person providing support

Angela Cranwell

Organisations
social services

Address/email address
County hall Bythesea Road Trowbridge Wiltshire

Phone no
not entered

Second person getting support from the health service, social services, a support service, probation, a voluntary organisation or
other body or individual at the moment?
Yes

Who gets support

Elysia

Name of person providing support

Angela Cranwell

Organisations
Social Services

Address/email address
County Hall Bythesea Road Trowbridge Wiltshire

Phone no
not entered

Previous addresses
Guidance notes
It is important that you include where both applicants (Main and Joint if applicable) have lived over the last 5 years.

We need this information to establish your connection to the area and your previous housing circumstances.

Address History
Mr Christopher Daniel Mason (Primary applicant)
1
Current address Date lived at address
16 Ludlow Close Westbury Wiltshire BA13 3TQ
01/09/2010 to Present
Miss Laura Elvin (Joint applicant)
2
Current address Date lived at address
16 Ludlow Close Westbury Wiltshire BA13 3TQ
01/09/2010 to Present
Assured Shorthold Tenancy - Self contained property rented from a private landlord or a
Private Registered Provider such as a Housing Association.

Assured Tenancy - Tenancy with a Private Registered Provider, such as a Housing Association.

Introductory Tenancy - Tenancy offered to new tenants by a Local Authority, usually for the first 12 months.

Starter Tenancy - Tenancy offered to new tenants by a Private Registered Provider, such as a Housing Association, usually for
the first 12 months.

Secure Tenancy – Tenancy with a Local Authority, normally after 12 months.

Employment and financial details

Guidance notes
If you have more than one job, please put the job in which you work the longest hours each week and list the other jobs under
Work Address/Other Jobs.

You must tell us about any property you own or part own. If you are unable to sell it, you must tell us why. We may ask for proof
of this.

Main applicant

Employment status*
Employed

Employment type
Full Time

Employer
Caspian Networks Ltd

Work address/Other Jobs:

Trowbridge Retail Park, 235 BUSINESS PARK, Bradley Rd, Trowbridge BA14 0AZ

Please provide details of your monthly income for all jobs (If 0, please put a 0 in the box)

Employment income (after deductions, monthly)*

1100.00

Deductions from net earnings eg Council Tax, debt repayments, maintenance, fines, court orders
300

Income-replacement benefits (monthly)*

200.00

Please indicate which of these benefits you receive

Universal Credit
 Carer's allowance
Council Tax Reduction
Discretionary Housing Payments (DHP)
ESA
Housing Benefit (not applicable if receiving Universal Credit)
Income Support
JSA
Pension Credit
Statutory sick pay only

If in receipt of Discretionary Housing Payments (DHP), please indicate the end date of the award

not entered

Deductions from benefits eg Council Tax, rent arrears, benefits overpayments, utilities.
not entered

Payment to insolvency practitioner or similar

not entered

Please explain reason(s) for deductions or payments

not entered

Contribution-based benefits (monthly)

not entered

Please indicate which of these benefits you receive

ESA-CB
JSA-CB

Non-means tested disability benefits (monthly)

not entered

Please indicate which of these benefits you receive

Attendance Allowance
Disability Living Allowance
Personal Independence Payment

Other benefits
not entered

Child Maintenance - income from child(ren)'s parent, Child Support Agency or Child Maintenance Service (monthly)
not entered

Non-dependants' contributions (adult children, monthly)

not entered

Payments from boarders or lodgers (monthly)

not entered

Child Benefit (monthly)*

147.00

Tax Credits (monthly)*

561.00

Personal Pension (monthly)*

0

State Pension (monthly)*

0

Any other income (monthly)*

0

Total monthly income

2008

Do you have any savings or investments?*

No

If you have ticked 'yes' please tell us how much (£)

not entered

Do you own a home, property or land (anywhere in the world)?*

No

If Yes, please insert full address of the home, property or land and details of its use eg our holiday home or let to tenants
(where let to tenants, please include name and contact details)
not entered

If you are not seeking Extra Care Housing, supported or sheltered housing, please provide a copy of a current valuation and,
where the property is mortgaged, a copy of statement showing the current redemption figure
not entered

If 'yes' please enter approximate market value

not entered

Do you have a mortgage?*

No

If you have ticked 'yes' how much do you have to pay? Please state the value from your last mortgage statement (£)
not entered

Years
not entered

Months
not entered

Please provide details of your mortgage lender

not entered

If you are an owner-occupier with a mortgage, are you able to afford the repayments?
not selected

If no, have you taken advice to help manage your budget (whether on-line or from a local advice service) and been advised that it
is unaffordable?
not selected

Please provide the advice service's name and contact details

not entered

If you are in rented accommodation, are you able to afford the rent and meet your essential living costs?
not selected

If no, have you taken advice to help manage your budget (whether on-line or from a local advice service)?
not selected

If yes, what was the outcome? (no resolution yet/advice service cannot resolve)
not selected

Do you have any rent arrears or other housing related debt (eg damage recharges, legal costs)?*
No

If you do have arrears or other housing related debt, please provide details
not entered

How much do you owe?

not entered

What is the name and address of the landlord who you owe the debt too?
not entered

Have you been making regular repayments for 6 months or have you paid over half the debt from its highest point?
not selected

If you have been making repayments, please provide details of the repayments made (NB Please also provide a copy of a
statement showing these repayments when you submit supported documents):
not entered

Joint applicant

Employment status
Employed

Employment type
Casual Work

Employer
The Shine Group Ltd

Work address/Other Jobs

9 Silver Street Trowbridge Wiltshire BA14 8AA

Please provide details of your monthly income for all jobs (If 0, please put a 0 in the box).

Employment income (after deductions, monthly)

0

Deductions from net earnings eg Council Tax, debt repayments, maintenance, fines, court orders
0

Income-replacement benefits (monthly)

0

Please indicate which of these benefits you receive

 Universal Credit
Carer's allowance
Council Tax Reduction
Discretionary Housing Payments (DHP)
ESA
Housing Benefit (not applicable if receiving Universal Credit)
Income Support
JSA
Pension Credit
Statutory sick pay only

If in receipt of Discretionary Housing Payments (DHP), please indicate the end date of the award

not entered

Deductions from benefits eg Council Tax, rent arrears, benefits overpayments, utilities
not entered

Payment to insolvency practitioner or similar

not entered

Please explain reason(s) for deductions or payments

not entered

Contribution-based benefits (monthly)

not entered

Please indicate which of these benefits you receive

ESA-CB
JSA-CB

Non-means tested disability benefits (monthly)

not entered

Please indicate which of these benefits you receive

Attendance Allowance
Disability Living Allowance
Personal Independence Payment

Other benefits
not entered

Child Maintenance - income from child(ren)'s parent, Child Support Agency or Child Maintenance Service (monthly)
not entered

Non-dependants' contributions (adult children, monthly)

not entered

Payments from boarders or lodgers (monthly)

not entered

Child Benefit (monthly)

not entered

Tax Credits (monthly)

not entered

Personal Pension (monthly)

not entered

State Pension (monthly)

not entered

Any other income (monthly)

not entered

Total monthly income

0

Do you have any savings or investments?

No

If you have ticked 'yes' please tell us how much (£)

not entered

Do you own a home, property or land (anywhere in the world)?

No

If Yes, please insert full address of the home, property or land and details of its use eg our holiday home or let to tenants
(where let to tenants, please include name and contact details)
not entered
If you are not seeking Extra Care Housing, supported or sheltered housing, please provide a copy of a current valuation and,
where the property is mortgaged, a copy of statement showing the current redemption figure
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If 'yes' please enter approximate market value

not entered

Do you have a mortgage?

No

If you have ticked 'yes' how much do you have to pay? Please state the value from your last mortgage statement (£)
not entered

Years
not entered

Months
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Please provide details of your mortgage lender

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If you are an owner-occupier with a mortgage, are you able to afford the repayments?
not selected

If no, have you taken advice to help manage your budget (whether on-line or from a local advice service) and been advised that it
is unaffordable?
not selected

Please provide the advice services name and contact details

not entered

If you are in rented accommodation, are you able to afford the rent and meet your essential living costs?
not selected

If no, have you taken advice to help manage your budget (whether on-line or from a local advice service)?
not selected

If yes, what was the outcome? (no resolution yet/advice service cannot resolve)
not selected

Do you have any rent arrears or other housing related debt (eg damage recharges, legal costs)?
No

If you do have arrears or other housing related debt, please provide details
not entered

How much do you owe?

not entered

What is the name and address of the landlord who you owe the debt too?
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Have you been making regular repayments for 6 months or have you paid over half the debt from its highest point?
not selected

If you have been making repayments, please provide details of the repayments made (NB Please also provide a copy of a
statement showing these repayments when you submit supported documents):
not entered

About where you live now

Guidance notes
This section and the following section are designed to elicit as much information about your housing circumstances as
possible. Please give full details at each stage.

Details about your current property

What type of property are you currently living in?*
House

If 'other', please specify

not entered

Has your property been adapted to suit the physical requirements of anyone in the household?*
No

If 'yes' please specify

 not entered

What is your current living situation?*

Private tenant

If 'Private', 'HA' or 'Council' tenant please give name of landlord

Ms Sharon Rossiter

Other - please explain

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Which floor is your property on?*

Not Applicable

How many bedrooms are in your property?*

2

Housing circumstances

Do you or anyone else in the household require an overnight carer?*

No

Are you genuinely likely to lose your present accommodation in the near future?*
No

If you have ticked 'yes' , who has asked you to leave? (e.g. friends, landlord, family, employer etc)
not entered

and by what date?

not entered

If you are at risk of losing your home this information will be passed to the council’s Housing Options team, which assists
those at risk of homelessness

Local Connections
Local Connections
A parish connection will be based on the following criteria:-

LIVE IN AREA- A person who is resident in that area. The residency will need to be permanent and have lived in the parish for
the last 12 months.

EMPLOYED IN AREA- A person who is in permanent paid employment or has a fixed term contract for a minimum of one year
or an offer of permanent paid employment in the area or a contract of a minimum of 12 months, or is self-employed and
works predominately in the area.

FAMILY IN AREA- A person with close family (grand-parents, parents, legal guardian, adult children or brothers and sisters)
who have lived in the parish or town for 5 years or longer.

Priority will be given to all parishes and towns where you have a confirmed local connection. If you are from our local
connection exclusion group you will be treated as having a connection to all parishes.

If you have a connection, please say which parish and town and state the reason for that connection.

To select your local connection, first highlight Wiltshire as the LOCAL AUTHORITY and click the 'List' button. This will display
the regions within Wiltshire that can be selected.

Next highlight the appropriate REGION. If you click 'List', this will display all the areas within that region that can be selected. If
you use either 'Add' button you will be saying that you have a local connection to ALL areas within the region(s).

Finally, highlight the appropriate AREA, then click the >> button to add them as the area to which you are connected. You can
select multiple areas by using the Ctrl key. If an area is selected by mistake, click << to remove it.

On the next page, you will be asked details of what your connection is to the selected areas.

If you have confirmed 'family live in area' as a reason for having a local connection to any parish or town, please provide the
name of the family member, their relationship to you, address details and how long they have been at that address.

Trowbridge
Wiltshire

Family live in area

From: 01/01/1990 To: 08/02/2018
Sister Lives in trowbridge.
 Westbury
Wiltshire

Live in area
From: 01/09/2009 To: 08/02/2018
7 year old daughter attends Westbury Junior School full time and 3 year old son attends Daisy Chain Nursery School in
Westbury

About the property you would like

Preferred Area
For monitoring purposes only:

What preferred area of Wiltshire Council’s area would be your first choice?*
Westbury

Guidance notes
Sheltered
For households over retirement age or a proven medical need. Accommodation generally consists of bungalows or flats.

Extra care housing

Applicants over 55 years of age with a need for additional care or support but still wishing to live independently. This may
include some applicants under 55 depending on the scheme and any restrictions applying to it.

Low cost home ownership

Options for people wishing to purchase affordable housing.

Private rental option

NB Wiltshire Council does not act as an agent for any private sector landlords at present (this option exists in case the council
chooses to adopt such a scheme).

Keyworker
For households working in education, police, fire departments, social care or health. NB Wiltshire Council does not operate a
keyworker scheme at present (this option exists in case the council chooses to adopt one).

Specialist Accommodation
This is accommodation that has been designated to meet a specific support need, for example for people with learning
disabilities or continuing mental health conditions.

We do not ask for details about any pets you have, however please be advised that some Housing Associations do not allow
pets into some types of accommodation. Please read the advertisement carefully for further information.

Bungalows owned and managed by Wiltshire Council in the south of the county are not normally allocated to households
under 60yrs of age (or 55 yrs, in certain schemes), unless an applicant has need of ground floor accommodation, where this
type of accommodation is required.

Desired property details

Do you wish to be considered for any accommodation OTHER THAN general needs affordable housing, such as

Extra care housing

Keyworker accommodation
Low cost home ownership
Private rental options
Sheltered accommodation
Specialist accommodation

Extra Care Housing

Extra care housing can provide an alternative to residential care, nursing care, supported living and sheltered housing for
people aged 55 and over. It is sometimes called ‘very sheltered housing’ and provides facilities and 24 hour care services
which allow people to remain independent for as long as possible. It can provide ‘a home for life’ for active older persons as
their care needs change over time.

Sheltered Housing
Sheltered housing is a self-contained flat or bungalow for older people with low support needs (thresholds of 50, 55 and 60
years+ depending upon the scheme). Support is generally by telephone or occasional visits. NB Schemes no longer have
resident wardens.
Specialist Accomodation
Specialist accommodation is aimed at people with learning disabilities and/or continuing serious mental health problems
and care needs. Schemes are specifically developed for these client groups

Are you currently in receipt of care? If so how many hours do you receive each week?
not entered

Do you require ground floor accommodation?*

No

If 'yes' please explain why

not entered

Do you require adapted or wheelchair accessible accommodation?*

No

If yes, please select the adaptations needed from the list

Adapted Kitchen
Level Access Shower
Level Access/Access Ramps
Parking at property
Stair Lift
Through Floor Lift
Wheelchair Accessible

Has this been assessed by an occupational therapist?*

No

If 'yes' please provide the occupational therapist's name

not entered

Has an Occupational Therapist recommended the need for an additional bedroom?*

No

Do you have a disabled child who requires a separate bedroom?*

No

Reasons for seeking alternative accommodation

Guidance notes
Please set out fully the reasons that you are seeking alternative accommodation and that your present home is unsuitable

Reasons for seeking alternative accommodation

Please provide as much detail as possible *
Our two children (male aged 5 and female aged 9) are currently sharing a small bedroom. Oscar, the younger child, has a
medical condition which severely affects his behaviour and mental functioning. It is the opinion of multiple H&SC professionals
that both children are being negatively affected by their cramped accommodation and lack of personal space, and that both
would significantly benefit from having their own, separate, bedrooms.

Does either the main applicant or joint applicant experience difficulties with reading or writing?*
No

Do you need further information about Choice Based Lettings?*

No

Do you require assistance with the bidding process? NB Please note that the Homes4Wiltshire cannot provide assistance
with bidding. We ask this question to help discussion about what help you might need?*
No

Are you either employed by, or related to a member of staff or board members of Wiltshire Council or housing providers?
not selected

If you have said yes, please let us know who, and which organisation they work for
not entered
Declaration & confirmation
Guidance notes
Deliberately providing false information or failing to ensure that the information held by Wiltshire Council in relation to your
housing application for the purpose of obtaining an affordable home is a criminal offence.

It is expected that, when your circumstances change, you will log on and update your personal details and/or your application
form. Failure to update your application or inform us of changes to your circumstances before receiving an offer of a property
may lead to you being prosecuted and/or losing your offer of accommodation. If you have already signed for and taken up a
tenancy, legal action may be taken to end the tenancy.

Sharing and Storing of your information

We will look after your information, keep it secure, and process it in compliance with all current data protection legislation
including the Data Protection Act and the General Data Protection Regulation. Please note that Wiltshire Council has an
information sharing protocol with other statutory bodies and agencies including housing providers to ensure that where we
work jointly, for example in relation to the meeting of care needs, and the prevention of crime and anti-social behaviour, we
work effectively.
Please confirm your understanding that we work with information about your housing need and circumstances relevant to
your housing need, including your housing conditions, the membership of your household, income and capital, management
of your housing debts, your connections to the council’s area and particular parishes, and your care and support needs,
which we exchange where necessary with other people and organisations to check its accuracy and to decide whether an
allocation of accommodation or a nomination to a housing provider is appropriate. We will only share information where it is
legitimately required in the course of the business.

The other people and organisations with whom we will exchange information include, but are not limited to, other local
authorities, housing providers, private landlords, social care professionals, GPs and other medical professionals, health
visitors, the police, probation, solicitors, care and support providers, advice organisations, Her Majesty’s Revenue and
Customs and the Department of Work and Pensions.

The primary objective of exchanging your personal information is to ensure that we make appropriate decisions about any
allocation of accommodation or nomination for accommodation we make on your behalf. A secondary objective is to prevent
fraud and ensure that public funds are not misused. By signing this form, you are making an informed agreement to the
council storing your personal information, sharing your information with any third party necessary to achieve these objectives
and receiving information to achieve the same objectives.

Important note
Deliberately providing false information for the purpose of obtaining a social rented home is a criminal offence.
We need to know about changes to your housing conditions, the membership of your household, income and capital,
management of any housing debts and connections to Wiltshire Council’s area and particular parishes. Failure to provide full
and accurate information, to update your application online (or otherwise update us) with changes to circumstances relevant
to your housing need before receiving an offer of a home may lead to you being prosecuted and/or the loss of an offer of
accommodation or tenancy.

Marketing
From time to time, the council and its partners may contact you about affordable homes in which you may be interested.

Application reference
Please make a note of your details, you will need them for future reference.

Unique reference number

HR91998-2

Declaration

Declaration
I declare that I have understood the above statements about the storage and use of my personal data and that the information
I have given is truthful
I understand that the council may exchange information with other local authorities, housing providers, private landlords,
social care professionals, GPs and other medical professionals, health visitors, the police, probation, solicitors, care and
support providers, advice organisations, Her Majesty’s Revenue and Customs and the Department of Work and Pensions
and any other person or organisation to ensure that appropriate decisions about my entitlement to any allocation of
accommodation to me or nomination for accommodation are made.

I agree to receive information about affordable homes in which I may be interested from Wiltshire Council and its partners.
To opt out of receiving information about affordable homes, please tick the box here.*
No

Even if someone else has filled in this form for you, you must sign this declaration if you can. If you have a partner, they must
sign this declaration as well.
Main applicant*
Yes

Date*
02/10/2019

Joint applicant
Yes

Date
02/10/2019

If you are completing this form on behalf of the applicant please explain why you are completing the form
not entered

Name of the person who filled in the form

not entered

Relationship to the person applying

not entered

If this form has been filled in by someone other than you or your partner, please read the form carefully and confirm using the
tickboxes.

The application was filled in for me and I have checked the details before signing it.

Main applicant confirmation*

No

Date
not entered

Joint applicant confirmation*

No

Date
not entered