If your circumstances change in any way following your MySARH registration you will need to complete the below form. Name* First Last Date of birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Registration number* Please confirm or update your current contact detailsHome or mobile phone Work phone Email What would you like to do?Changes to application* Remove my application Change of address Add an adult, add a child or change a name Remove a person from the application Baby due Change of addressNew address Street Address Address Line 2 City State / Province / Region Post code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date moved inDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please select the option that best describes your circumstances Tenant Homeowner Living with relatives Living with friends Please provide the full name and address of your landlordWhat kind of property is it?HouseFlatBungalowCaravanOtherIf other, please describeHow many bedrooms does the property have in total? Additional informationPlease enter information ONLY for the person or people to whom the change of circumstances relates and only if they are moving with youNameGenderDate of birthRelationship to youNI number (if applicable)Enter address (if different)Add or remove? Medical conditionsDoes anyone in your household have any medical conditions that have developed or changed since your application for housing? (If you answer yes to this question we will send out a medical form for you to complete and return to SARH) Yes No PregnancyIs anyone on your application form pregnant? Yes No Name First Last Due date Contact address (if different)Information to applicantsApplicants 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 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 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. If you feel your circumstances have changed other than what has been detailed on this form, please contact the Choice Based Lettings team on homes@sarh.co.uk to speak to a member of the team to discuss further.CAPTCHANameThis field is for validation purposes and should be left unchanged.
