Application form – Hereford Lettings

Applicant 1: First name *

Applicant 1: Surname *

Applicant 1: Date of birth *

Applicant 1: Full address and postcode *

Applicant 1: Are you currently renting? *

Yes
No

Applicant 1: Telephone number *

Applicant 1: Email address *

Applicant 1: Employment status *

Employed full-time
Employed part-time
Self-employed
Unemployed
Retired

Applicant 1: Name of employer * Or business if self-employed

Applicant 1: Total income (annual) *

Applicant 1: Benefits received *

None
Housing Benefit
Universal Credit
Child Benefit
Tax Credits
Disability Benefit
Other

Applicant 1: Other benefit details *

Applicant 1 - Have you ever had a CCJ (County Court Judgement) made against you? *

No
Yes - Satisfied (I have paid off the debt in full)
Yes - Not Satified (Not fully paid off)

Applicant 1 - Have you had more that one CCJ?

Yes
No
Not applicable

Are you applying for a joint tenancy with another adult? *

Yes
No, myself only

Applicant 2: First name *

Applicant 2: Surname *

Applicant 2: Date of birth *

Applicant 2: Full address and postcode *

Applicant 2: Are you currently renting? *

Yes
No

Applicant 2: Telephone number *

Applicant 2: Email address *

Applicant 2: Employment status *

Employed full-time
Employed part-time
Self-employed
Unemployed
Retired

Applicant 2: Name of employer * Or business if self-employed

Applicant 2: Total income (annual) *

Applicant 2: Benefits received *

None
Housing Benefit
Universal Credit
Child Benefit
Tax Credits
Disability Benefit
Other

Applicant 2: Other benefit details *

Applicant 2 - Have you ever had a CCJ (County Court Judgement) made against you?

No
Yes - Satisfied (I have paid off the debt in full)
Yes - Not Satisfied (Not paid off in full)

Applicant 2 - Have you had more that one CCJ?

Yes
No
Not applicable

Do you have children (under 18) living with you? *

Yes
No

Please provide sex and age for every child under 18 *

Do you or does anyone else in your household smoke? *

Yes
No

Do you have any pets? *

Yes
No

Please provide details of all your pets *

Consent for storing submitted data *

Yes, I give permission to store and process my data