Please complete the form below.   To make thinngs as easy as possible in assessing your application,   please give us as much information as possible: Fields marked [ * ] are required: Date:         Main Applicant: Title:*   Mr Mrs Ms Miss First Name:*   Last Name:*   Email:   Address Line 1: * Address Line 2: Town/City: *   PostCode: *   Lenght of stay at this address: *     Contact tel number:*   National Insurance Number:*     [Enter without spaces between letters/numbers. Eg.: AA112233B] DoB:*     Format: DD/MM/YYYY e.g. 19/04/1985 Ethnic Origin:   Please select: White_British White_Irish ------------------------- Mixed_White and Black Caribbean Mixed_White and Black African Mixed_White and Asian ------------------------- Asian or Asian British_Indian Asian or Asian British_Pakistani Asian or Asian British_Bangladeshi Asian or Asian British_Chinese ------------------------- Black or Black British_Caribbean Black or Black British_African ------------------------- Other If 'Other,' please write in: Are you:*   Male Female   Do you have any pets?*   Yes No If 'Yes,'  what kind and how many?             Details of people who live with you: A.     Title:   Mr Mrs Ms First Name:   Last Name:   Address Line 1: Address Line 2: Town/City:   PostCode:       National Insurance Number:   Relationship to main applicant:   DoB:   e.g. 19/04/1985 Ethnic Origin:   Please select: White_British White_Irish ------------------------- Mixed_White and Black Caribbean Mixed_White and Black African Mixed_White and Asian ------------------------- Asian or Asian British_Indian Asian or Asian British_Pakistani Asian or Asian British_Bangladeshi Asian or Asian British_Chinese ------------------------- Black or Black British_Caribbean Black or Black British_African ------------------------- Other If 'Other,' please write in: Are you:   Male Female       B.     Title:   Mr Mrs Ms First Name:   Last Name:   Address Line 1: Address Line 2: Town/City:   PostCode:       National Insurance Number:   Relationship to main applicant:   DoB:   e.g. 19/04/1985 Ethnic Origin:   Please select: White_British White_Irish ------------------------- Mixed_White and Black Caribbean Mixed_White and Black African Mixed_White and Asian ------------------------- Asian or Asian British_Indian Asian or Asian British_Pakistani Asian or Asian British_Bangladeshi Asian or Asian British_Chinese ------------------------- Black or Black British_Caribbean Black or Black British_African ------------------------- Other If 'Other,' please write in: Are you:   Male Female       C.     Title:   Mr Mrs Ms First Name:   Last Name:   Address Line 1: Address Line 2: Town/City:   PostCode:       National Insurance Number:   Relationship to main applicant:   DoB:   e.g. 19/04/1985 Ethnic Origin:   Please select: White_British White_Irish ------------------------- Mixed_White and Black Caribbean Mixed_White and Black African Mixed_White and Asian ------------------------- Asian or Asian British_Indian Asian or Asian British_Pakistani Asian or Asian British_Bangladeshi Asian or Asian British_Chinese ------------------------- Black or Black British_Caribbean Black or Black British_African ------------------------- Other If 'Other,' please write in: Are you:   Male Female             Your previous addresses for the last 5 years: [...most recent first...] NB.: Please fill these in if the length of stay at your CURRENT address is less than 5 years. 1.     Address:   Date From:   Date To: Name of Landlord or Mortgagor: Why did you leave?:   Tenure Type:   Please select: Owner Occupier Lodger New Charter Tenant Other Housing Assoc Tenant Council Tenant Accommodation tied to job Other If 'Other,' please write in:             2.     Address:   Date From:   Date To: Name of Landlord or Mortgagor: Why did you leave?:   Tenure Type:   Please select: Owner Occupier Lodger New Charter Tenant Other Housing Assoc Tenant Council Tenant Accommodation tied to job Other If 'Other,' please write in:             3.     Address:   Date From:   Date To: Name of Landlord or Mortgagor: Why did you leave?:   Tenure Type:   Please select: Owner Occupier Lodger New Charter Tenant Other Housing Assoc Tenant Council Tenant Accommodation tied to job Other If 'Other,' please write in:             4.     Address:   Date From:   Date To: Name of Landlord or Mortgagor: Why did you leave?:   Tenure Type:   Please select: Owner Occupier Lodger New Charter Tenant Other Housing Assoc Tenant Council Tenant Accommodation tied to job Other If 'Other,' please write in:                   Employment details:     Occupation:   Employer's Name:   Employer's Address:   Employer's Telephone Number :   Employer's Email Address:   How long have you been with this employer?:         Any other additional information? Please use the box below to give any other informatuion that you may think is helpful to assess your application:                 Community Safety:           New Charter wants to ensure that our neighbourhoods allow people to live peacefully and safely. If someone has been convicted of a serious criminal offence, we will investigate the circumstances to establish whether they pose a risk to the community.       Have you, or anyone who will live with you, ever been convicted of a criminal offence or an offence that threatened the local community or been given an anti-social behaviour order?   Yes No       Are you, or anyone who will be living with you, currently subject to any criminal proceedings?   Yes No       If the answer to any of the above questions is “yes”, please provide the name(s) of the person(s) with the conviction         References:       You will need to provide a minimum of two references from any of the following and bring them along with you when you are invited:     -- Landlord     -- Mortgagor     -- Employer     -- Bank Statements for the last 3 months       Terms & Conditions:       I acknowledge that the information I have provided in this form and any further information I may provide to you in connection with my application or any subsequent tenancy will be accurate and true. I acknowledge that any such information can be used by New Charter in the administration of any application for housing, and management and termination of any tenancy I am offered. I acknowledge that such information may be shared with other relevant agencies and organisations in connection with my application and any subsequent tenancy. If my application is found to contain false or misleading information, or relevant information is omitted, I understand it may be suspended. I also consent to New Charter contacting other agencies to verify the information I have supplied and to seek further detail if necessary.         *   Please tick the checkbox to indicate that you have read the above Terms & Conditions.       NB.: You will be asked to sign and date the form/agreement when you are invited.             Note: Print the form for your copy. [before submitting...]