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Sandwell Homes Ltd
Sandwell Road
West Bromwich
Sandwell
West Midlands
B70 8TQ
Tel: 0121 569 6500
Fax: 0121 569 6015
Minicom: 0121 569 5047
Text: 07800 140 065
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Housing Registration Form

To register with Sandwell Homes Property Shop you will need to complete a Housing Registration Form, available from any of our Neighbourhood Offices or Property Shops, by clicking here to download the Housing Registration Form in Adobe PDF format, or alternatively using the electronic form below.

Please complete to form by answering all relevant questions, including those for a Joint Applicant if applicable. As part of the registration process we will need to confirm some details. Please click the links below for additional information on what details we require from you.

Once we have received all relevant details we aim to process your Housing Registration within 5 working days. If we are unable to register your application for any reason we will write to tell you why.

Related Documents
Housing Registration Form
Applicant Details Joint Applicant Details
Title Title
Surname Surname
First name(s) First name(s)
Other name(s) Other name(s)
Sex   Sex  
National Insurance Number National Insurance Number
Date Of Birth Date Of Birth
Address Address
Telephone - Home Telephone - Home
Telephone - Mobile Telephone - Mobile
Telephone - Work Telephone - Work
E-Mail Address E-Mail Address
Are you pregnant?   Are you pregnant?  
If Yes, what is your date of confinement?
Please produce your certificate of confinement		 If Yes, what is your date of confinement?
Please produce your certificate of confinement
What is your status at your current address?




What is your status at your current address?




If Other please state If Other please state
Current Landlords name and Address if applicable Current Landlords name and Address if applicable
  Relationship to main applicant

Please give the details of anyone else who would be housed with you
Surname First name(s) Relationship to you Date of Birth Disabled Sex Address if different from above






Please list all previous addresses for you for the past six years
Address From To Status (lodger, tenant etc) Reason for leaving Previous landlord & address

We may contact your previous Landlord to confirm how you conducted your tenancy.

Please list all previous addresses for your Joint Application for the past six years
Address From To Status (lodger, tenant etc) Reason for leaving Previous landlord & address

Medical Factors / Special Circumstances / Requested Sheltered Housing

If there are any medical factors or any other special circumstances which my affect your housing needs or those of anyone moving in with you, please give the basic details below (it is likely that these details will need to be investigated further). Please indicate if you wish to be considered for Sheltered Housing (property with a Warden)

Do you need assistance in applying for housing? For example, problems that affect your ability to access our Property Adverts?
Name Details

Ethnicity
  Applicant Joint Applicant
White
British
Irish
Other (please state)
 
Mixed
White & Black Caribbean
White & Black African
White & Asian
Other (please state)
 
Black / Black British
Caribbean
African
Other (please state)
 
Asian / Asian British
Indian
Pakistani
Bangladeshi
Other (please state)
 
Chinese / Other Ethnic Group
Chinese
Gypsy / Traveller
Other (please state)

Religion / Belief
  Applicant Joint Applicant
Christian (Please Specify)
Sikh
Muslim / Islam
Hindu
Buddhist
Jewish
Other (Please Specify)
No Religion

Sexual Orientation
  Applicant Joint Applicant
Heterosexual / Straight
Gay
Bisexual
Unsure

Communication
  Applicant Joint Applicant
Do you speak English?   No   No
If No, please state main language spoken
Do you need an interpreter?   No   No
Would you require any translated documents?   No   No
If Yes, please state the main language read
Are you subject to any form of immigration control?   No   No
Please state if you have any problems affecting your ability to communicate
Do you need the services of a Sign Language Intepreter?   No   No
Do you need documents in Braille?   No   No
Do you need documents in large print?   No   No
Do you need documents on audio tape or CD?   No   No

Under the Disability Discrimination Act 1995, the disability is defined as a physical or mental impairment that has substantial and long term, negative effect on a persons ability to carry out day to day activities. The following information will help us change the way we offer services to you.

Disability
  Applicant Joint Applicant
Do you have a disability, impairment or long term medical condition?
If yes, please tick any boxes that apply to you
Blind
Visually Impaired
Deaf
Hard of hearing
Wheelchair user
Other mobility issues (please specify)
Mental health issue
Learning disability
Unseen impairments (e.g. dyslexia, diabetes, HIV, arthritis - please specify)
Other (please specify)

Do you or any members of your household have any criminal convictions or anti social behaviour or legal notices / orders against you? These include past and pending court orders. If so please give details below.

Are you or anyone to be rehoused with you related to anyone working for Sandwell Homes or Sandwell Metropolitan Borough Council, an elected member or Board Member, a Councillor or Member of Parliament? If so, please give details below.

Please provide any further information that you feel is relevant to your Housing Application.

Declaration
I / We declare that the information given on this form is true and complete to the best of my / our knowledge and understand that if I / we have given false or misleading information then I / we may lose the accomodation obtained. If I / we apply for a RSL (Housing Association) or Private Landlord Property through the choice based lettings scheme, I / we understand that my / our details may be sent to the relevant Landlord for consideration.

I / We authorise Sandwell Homes to make any necessary enquries regarding this application with any other agencies required. I / We will notify Sandwell Homes of any change in circumstances that may affect my / our application.

Information supplied on this form will be processed in accordance with the Data Protection Act 1998.

 I / We accept the above terms and conditions.
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