Solihull Home Options

Tuesday, 06-Jan-2009

Online application form

Section A - Main Applicant (yourself)

If you have already started to complete this application form and have been issued a reference, then please enter it below along with the date of birth of the main applicant to retrieve your saved details.

Reference number:

Date of birth: (dd/mm/yyyy)

Otherwise, please start entering your information below. Note that questions marked with * are mandatory for you to answer.

Main Applicant

Applicant Details

Title:*

First name:*

Surname:*

Previous name:

Gender:*

Marital status:

Date of birth:* (dd/mm/yyyy)

National Insurance Number:

Address 1:*

Address 2:*

Address 3:

Address 4:

Postcode:*

Date moved in to this address:* (dd/mm/yyyy)

Home telephone:

Work telephone:

Mobile telephone:

Email:

You should complete this form if you and all members of your household have the right residence and public funds in this country. Please refer to section X of leaflet Y.

Do you have the right to reside in this country? yes no

If the answer is No, please supply details of your current status in relation to the conditions of your residence in the UK.

Reason:

Solihull Community Housing wants to make sure that we treat our customers fairly and that they all have equal access to our services and that no one is treated unfavourably on the grounds of race, nationality, ethnic origin, sex, sexuality, age or disability

Ethnic Origin:

Solihull Community Housing considers a person to be vulnerable if they need community care services to reach a reasonable standard of health and development because of disability (including mental disability), illness, age or a harmful environment. A person who is or may be unable to take care of him/herself, or who is unable to protect him /herself against significant harm is also considered vulnerable.

Do you consider yourself vulnerable?

Are you pregnant? yes no

If yes, when is the baby due? (dd/mm/yyyy)

Contact address

Would you like us to contact you through someone else?

Please skip rest of this section if answer to previous question is 'No'

Their name:

Their address:

Their telephone number:

Their email address:

Their relationship to you:

Same address as main applicant: yes no

If yes, then please ignore the following address fields

Address line 1:*

Address line 2:*

Address line 3:

Address line 4:

Postcode:*