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Application form

If you wish to apply to rent or for shared ownership where subsidy is involved you will need to print and complete the form below. You can save the form at any time. It will be stored against your email address.


Once you have completed and signed the form, please forward it to:
Yourspace homes
Myriad House
23 Springfield Lyons Approach
Chelmsford
CM2 5LB


You will also need to attach:

  • a copy of your passport or driving license
  • copies of two different utility bills
  • copies of your last three wage or salary slips
  • proof of savings or other income (E.g.: tax credit award)

 

Section one: Lead applicant details
Title :
First Name :
Surname :
Address :
Postcode :
Tel Home :
Tel Work :
Mobile :
Email :
Date Of Birth :
(dd/mm/yyyy) 		/ /
NI No :

Section two: Joint applicant details (if applicable)
First Name :
Title :
Surname :
Address :
Postcode :
Tel Home :
Tel Work :
Mobile :
Email :
Date Of Birth :
(dd/mm/yyyy) 		/ /
NI No :

Section three: Your family and household details
Please give details of the people who would live with you if you were offered accommodation.
Household Details :
Are you or is any of the people who live with you expecting a baby? : Yes    No
If yes, when :

Section four: Income details
Please give all employment details about yourself and everyone who will be living with you.
Income Details :

Section five: Other income
Please give details about other income either you or anyone who will be living with you has e.g. benefits/pension/maintenance payments.
Other Income :

Section six: Savings or other assets
Please give details of any savings or other assets.
Savings or other assets :

Section seven: Financial commitments
Please give details about any regular payments e.g. loans, hire purchases, credit cards, that you or anyone who will be living with you has to make.
Financial commitments :

Section eight: Rent and mortgage arrears
Do you or the joint applicant have any outstanding arrears on either a current or previous property? : Yes    No
To whom do you owe these arrears :
Have you ever been bankrupt or insolvent, or had any judgement made against you for debt? : Yes    No
If yes, please give details :

Section nine: Medical information
Do you or any of the people who will live with you suffer from an illness or disability? : Yes    No
If yes, give the name of the person and details of illness or disability :

Section ten: Your present accommodation
Owner occupier : Yes    No
If you are already an owner occupier please give reasons why you are applying for this accommodation :
Private tenant : Yes    No
If you are a tenant please give the landlords name and address :
Council or Housing Association : Yes    No
Are you registered on a council waiting list? : Yes    No
If yes, give details of council and date registered :
Are you registered on a housing association waiting list? : Yes    No
If yes, give details of housing association and date registered :
Have you ever rented or bought a property form yourspacehomes or CHP? : Yes    No
If yes, please give details :
Have you ever been an owner occupier in the past? : Yes    No
If yes, please give details :

Section eleven: Your preferred housing
What type of property do you want?
Studio
Apartment
House
Bungalow
Retirement
Sheltered
How many bedrooms do you require :
In which area do you want to live :
Have you seen a yourspacehomes property you are interested in? : Yes    No
If so, please give details i.e. location, scheme name etc :

Section twelve: Your main reasons for applying
What are your reasons for wanting to move?
Moving to provide support for family members
Moving because you are overcrowded
Moving because of problems (intimidation, harassment, etc)
Moving where house prices are higher
Moving because current home is in poor condition
Moving because current home is not suitable for your medical needs
Moving because unable to buy a property on the open market
Other - please specify :

Section thirteen: Supporting information
Please write down any other information that you think is important to your application attaching copies of any relevant documents i.e. doctors letters, notice to quit, etc.
Supporting Info :

Section fourteen: Relationship to staff or committee
Are you an employee or member of yourspacehomes or CHP, or a relative of one : Yes    No
If yes, give details :

Section fifteen: Where did you hear about yourspacehomes
Signboard
Leaflet
Advertisement
Newsletter
Local authority
Web site
Friend or relative

Section sixteen: Other information you MUST supply
In order for us to assess your eligibility accurately please provide the following:
Copy of your passport or driving license
Copies of 2 different utility bills
Copies of your last 3 wage slips
Proof of savings or other income (e.g. tax credit award)
Please forward to: yourspacehomes, Myriad House, 23 Springfield Lyons Approach, Chelmsford, Essex, CM2 5LB

Section seventeen: Declaration
a) I understand that the information provided on this form will be used by yourspacehomes for the purpose of processing my application. I will be treated in the strictest of confidence in accordance with the terms of the Data Protection Act 1998.
b) I understand that as part of yourspacehomes’ statutory duties to protect public funds and prevent and detect fraud information relating to this application may be disclosed for the purpose of crime prevention and detection in accordance with the terms of the Data Protection Act 1998.
c) I understand that yourspacehomes reserves the right to take up references relating to this application including, where appropriate, employment, loan, landlord and financial checks.
d) I understand that if I am a council or housing association tenant that I will have to give up my existing accommodation on the day of completion.
e) I understand that my home will be at risk if I do not keep up my mortgage and/or rent payments.
f) I am a British or EU citizen or have indefinite leave to remain in the UK.
g) I certify that the details given on this application are true and complete to the best of my knowledge.
Applicant 1
Applicant 2