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Tuesday, 06-Jan-2009
Online application form
Online application form
Section A - Main Applicant (yourself)
Log in
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:*
**Please Choose**
Miss
Mr
Mrs
Ms
First name:*
Surname:*
Previous name:
Gender:*
**Please Choose**
Female
Male
Marital status:
**Please Choose**
Civil partnership
Single
Co Habiting
Divorced
Married
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:
**Please Choose**
White - British
White - English
White - Irish
White - Scottish
White - Welsh
White - Other
Asian / Asian British - Bangladeshi
Asian / Asian British - Indian
Asian / Asian British - Pakistani
Asian / Asian British - Other
Chinese
Mixed - White / Asian
Mixed - White / Black African
Mixed - White / Black Caribbean
Mixed - Other
Black / Black British - African
Black / Black British - Caribbean
Black / Black British - Other
Irish Travellers
Other Ethnic
I do not wish to answer
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?
**Please Choose**
Yes
No
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 Choose**
No
Yes
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:
**Please Choose**
Aunt
Brother
Co-Habitee
Cousin
Daughter
Father
Husband
Mother
Nephew
Niece
No relationship
Other extended relation
Sister
Son
Step Daughter
Step Son
Uncle
Wife
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:*
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