Waiting List Review

Name (required):
Current Address:
UPIN (required):
Date of Birth (required):
 
Please confirm of update your current contact details
Telephone:
Home
Work
Mobile
Email:
 
Please tick the appropriate box (only answer the relevant questions)
 

Remove my name from the list
If you would like to remove your name from the list, tick the box and

No change to my application
If your circumstances have not changed, please the form now
Change of address
If you have moved address tick the box and - You now need to complete a new online application
Add an adult
(Proof required for additional adult only)
Removing a person from application
Change of name for existing applicant
(proof required)
Adding a child or baby due
(proof required)
 
Please enter person details that relate to the change of circumstances.
Forename Surname Sex DOB Relationship to you NI Number
if applicable		 Do they live at the
same address as you
(please select if applicable)
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
 
Is anyone on the application form pregnant?
Name
Date Baby Due (Please provide proof of pregnancy showing date baby due)
   

Update your medical needs
   
Do you think that you require
ground floor accommodation?		 Yes No
If yes, please say why you need
ground floor (eg medical reasons)
Would lift access be adequate? Yes No
Do you require wheelchair access? Yes No
Do you require other Aids or Adaptations? Yes No
If yes please list aids or adaptations
 
Please indicate if you would like information on
Housing Associations in Stafford Borough
Shared Ownership Schemes
Homebuy Schemes
Private rented Accommodation
Hostels
   
SARH have a Mutual Exchange List which is on public display at The Rurals for those tenants wishing to find an exchange between other SARH or RSL (housing association tenants) and Council Tenants
I am interested in being registered on the Mutual Exchange List (Please tick if interested)
(Please note that this will involve having your details on public display in Stafford & Rural Homes' offices and on the website and a form will be sent to you for completion.)
   

Update your references
You are required to supply two references, if you would like change the references from your original application please download new reference letters. One should be from your current or previous landlord if this is applicable to your circumstances. Other suggestions for references could be from your employer present or past or from a professional person who knows you.
WE DO NOT ACCEPT REFERENCES FROM FRIENDS OR FAMILY MEMBERS

Please ensure you complete all parts of this section in full otherwise we will not be able to process your information

Disclosure of Information
I/We agree that Stafford and Rural Homes will keep our personal information for use in the performance of any of its services, and agree that disclosure of relevant personal information can be made to other organisations working with Stafford and Rural Homes to deliver services or provide housing.

  • I/We understand that by giving a false statement and withholding information it is an offence (Section 171 of the Housing Act 1996) and if found guilty of this offence I/We may be liable for a fine of up to £5,000.
  • I/We confirm that the information given in this application form is correct to the best of my/our knowledge.
  • I/We agree to notify SARH of any changes in the details given in this form.
  • I understand that action can, and may be taken against me/us if I/we fail to provide up to date information regarding my/our circumstances.

By submitting this applicant you are agree that my personal information can be displayed on Stafford & Rural Homes Website and at its reception areas in order to improve my chances of finding a mutual exchange.

By submitting this form you certify that the information given on this form is correct, and you understand that, should it prove that a false statement has been made action may be taken against you.

Please ensure that you have provided proof, where required. All proofs must be dated within the last 4 weeks.
   
Is there any further information you feel that we should be providing? Yes No
If yes please supply details
Are you satisfied with the way we are dealing with your application? Yes No
If no please supply details
   

Information to Applicants

Applicants are able to:

  1. View information contained on our computer system
  2. Change information regarding areas of choice and circumstances
  3. Seek advice, guidance and information on re-housing options