ACCOMMODATION APPLICATION FORM

I/We……………………………………………….&……………………………………………….……
am/are applying for accommodation and hereby give my/our permission to make such enquiries as necessary to establish my/our status.

Would you please therefore release any information, which my prospective landlord may need in terms of references or to verify the information given below.

PREVIOUS ADDRESS

Occupied address………………………………………………………………………………………….

Dates occupied (from/to)………………………………………………………………………………….

Name/address of landlord…………………………………………………………………………………

……………………………………………………Tel. No……………………………………………….

EMPLOYER REFERENCE

1. Name………………………………………..2. Name………………………………………………...

Address………………………………………….Address………………………………………………..

……………………………………………………………………………………………………………..

Job Title………………………………………..Job Title………………………………………………...

Contact…………………………………………Contact………………………………………………….

PROFESSIONAL REFERENCE

Please give details of a professional person whom we may contact for a reference

Name…………………………………………..

Address…………………………………………………………………….Postcode…………………….

HOUSING BENEFIT INFORMATION

Details of last Housing Benefit Claim…………………………………………………………………….

Name you claimed under………………………………….Ref. No………………………………………

Claim address……………………………………………………………………………………………...

……………………………………………………………………………………………………………..

National Insurance no……………………………..Date of birth…………………………………………

Declaration I/We have given permission for our prospective landlord/s to approach those listed above and declare that no County Court Judgement has ever been made against me/us for non payment of rent.

Signed 1………………………………………….Signed 2……………………………………………