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TENANT APPLICATION FORM
Please Note: Families & Joint Claims will not be accepted.
First Name
*
Last Name
*
Phone Number
*
Email Address
Date of Birth
*
National Insurance Number
*
0 / 9
Are you claiming Universal Credit?
*
Yes
No
How much UC are you entitled to per month?
*
Does any of the below benefits apply to you?
*
PIP (Personal Independence Allowance)
ESA (Employment and Support Allowance)
LSW (Limited Capability for Work)
Carer’s Allowance
Disability Living Allowance
Guardian’s Allowance
Armed Forces Compensation Scheme
Armed Forces Independent Payment
War Pension
War Widows/ Widowers Pension
Industrial Injuries Benefit
Overstate Pension Age
NONE
How much do you receive per month from the benefits you have selected?
*
Are you working Full or Part time? Please state how many hours and the amount you receive per month.
*
0 / 100
What location would you prefer?
*
0 / 50
Have you been diagnosed with a mental health condition?
*
0 / 100
Any Criminal Convictions? Please note offence below, if any.
*
0 / 80
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