Application for Tenancy at Glawood House, Sompting Road, Worthing, West Sussex BN14 9ER
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If you would like to be put on our waiting list, with no obligation, please print out this form and send it by post to Glawood House, The Old Bakehouse, 22 South Street, Lancing, West Sussex, BN15 8AG:

1. Applicant's Personal Details

Full Name Mr / Mrs / Miss / Ms
Date of Birth   National Insurance Number  
Daytime Telephone Number  
Mobile Telephone Number  
Email Address  
Have you ever been known by any other name? If yes, please provide details and dates Yes / No

2. Address - Please supply your address(es) during the last 3 years starting with your current address. Continue on a separate sheet if necessary.

Lived there
From / To 		Address in full including full postcode (must be provided) Landlord's Name, Tel, Fax/email

If owner - Mortgage details including name and address of lender and account no.

 

 

 

 

    

 

 

 

 

  

 

3. Current Mortgage/Rent

Monthly repayments rent/mortgage £

Are you claiming Housing Benefit? Yes / No

4. Employment now/prior to retirement

Name and address of your present employer (or last job you had):

 

 

Name and contact details of your work

Tel no:                                              Fax no:

Email address:

 Your job/title or description

Dates of Employment                                From                                                                    To

Present Salary £

Or Present Pension £

Per week / month / year 

Per week / month / year 

Other income £       

Details

Are your employment circumstances likely to change in the period of the tenancy / the next year (whichever is shorter)?
If so, how?

 

 

5. Bank Details

Name of Bank (or Building Society)

 

 Sort code

Address of Branch

 

 

 Account Number

6. State of Health

Please give a brief history

 

 

Hobbies

 

 

7. Other

Do you have a pet?    Yes / No        If yes, please detail:

 

Do you smoke?    Yes / No        If yes, how many per day?

8. Contacts

Next of Kin  (or person to be contacted in the event of an emergency)

 

 Relationship

Address

 

 

Day Tel. No:

Evening Tel. No:

8. Applicant's Consent

I hereby expressly consent to my personal details including any forwarding address at the termination of any tenancy being passed to the landlord and/or to the utility company and/or to the local authority.  I understand that other than for reasons outlined above, all information will be treated as confidential.

 

Signature:………………………………………………................................                     Date:……………………………………….

13.           Declaration

13.1        I am applying for a tenancy on the basis that the property or accommodation will be my main or only home.
13.2        I give permission for enquiries to be made based on the information I have provided to establish my status.
13.3        I also certify that I do not

 

Signature:………………………………………………................................                     Date:……………………………………….

IF YOU KNOWINGLY SUPPLY FALSE INFORMATION IT MAY BE USED BY THE LANDLORD TO SEEK POSSESSION OF THE PROPERTY UNDER GROUND 17 OF THE HOUSING ACT 1988 (AS AMENDED BY SECTION 102 OF THE HOUSING ACT 1996).

The information on this form is for the sole use of the Landlord only for the purpose of letting.  No information contained therein will be divulged to any third party, unless the Tenant defaults.

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