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Before you start

It should take around 20 minutes to complete the application form. Please make sure you have the following information available for yourself and anyone else included in the application:

  • Postcode
  • National Insurance Number
  • Rent account number if you are a current tenant
  • Last 5 years' address history, including landlord or agent details if applicable

If you're using a shared or public computer, make sure you keep your personal information safe.

Don't leave your computer unattended with information on display, and be aware of who can see your screen.

Your details

Your contact details

Your address details

Your requirements

About you


Under the Data Protection Act we must tell you what we will use your personal details and sensitive data for and we must store it safely. The information you have given will be used to allow us to assess and prioritise your application for housing and correspond with you.

On occasion, we are required to supply statistics to organisations that regulate us. We will not divulge any information we hold about you unless you agree, we are required to do so by law or we have to do so in order to protect our rights.

I / we confirm that the information I / we have supplied is accurate and may be held by Housing & Care 21 in accordance with the particulars above. I / we understand that the completion of this form does not imply that I / we will automatically be entitled to an offer of accommodation.

You agree to inform us if your circumstances change.

You will submit your application on the next page.

We reserve the right to request references at a later date.

We reserve the right not to house you should you give false information.

Equality and diversity

This section is optional. If you don't want to answer these questions it will not affect your application. We monitor equality and diversity information to ensure that all applications are treated equally and fairly, and that our policies and procedures comply with legislation. The information you supply will not be used for selection purposes.