Section A – your present circumstances Name (Required)
First name Surname Address (Required) Property type (Required) Apart from those listed above, does anyone else live at your current property? (Required) If yes, please give details of all people living at the property. You must provide full name, date of birth and relationship to tenant for each person. Does any person living at the property have a physical disability? (Required) Do you have any support needs? (Required) Do you have a support worker, or receive support from an agency such as social services, mental health services, probation services, etc? (Required) Has the property been adapted in any way? (Required) Do you have any pets? (Required) Can you confirm why you wish to exchange? (Required) Have you or any member of your household received a tenancy warning for anti-social behaviour or any other tenancy breaches? (Required) Do you or any member of your household have spent or unspent convictions? (Required)
If yes, we may use your contact details to gather further information to understand your circumstances which may affect how your application proceeds.
Section B – Details of the person you wish to exchange with Address of the property you wish to move to (Required) Landlord's address (Required) Property type (Required)
Please note: we require these details in order to request a reference from their landlord. Without a reference your request to exchange will not be able to go ahead. It is your responsibility to provide the contact details of their landlord in order for us to arrange a timely response from them.
Tick to agree (Required)
Please tick to confirm that you have read and agree to the following statement. You accept the property as it stands together with the tenants obligations. You can still report any repairs due to fair wear and tear. However, internal decoration will be your responsibility. We have not performed any inspection and/or assessment of any gifted items whatsoever. We inspect and assess for suitability of use and safety. Any other type of assessment must be conducted by you and/or a professional instructed by you at your own cost. We will not be held responsible for any upkeep, repair, maintenance and/or replaced items whatsoever.
Section C – Data protection Please confirm (Required)
Please tick to confirm that you have read and agree to the following data protection statements. Information disclosed on this form is confidential. It will only be used by Housing Plus group for the purpose of considering your application for a mutual exchange. In processing this application we may need to provide third parties with personal information relating to you or members of your household or we may need to obtain personal information relating to you or members of your household from third parties. However, this will only be so that we can properly assess your application for housing. We may also disclose your personal details if required to do so by law or any Government body. Information held will be kept during the period your application is being considered and we may from time to time ask you to confirm its accuracy. In the event that you remain a customer with Housing Plus group the form will be retained as part of your tenancy record. For further information on data held about you and/or your family, please contact us.
Section D – Declaration Please confirm (Required)
Please tick to confirm that you have read and agree to the following declaration. I/We understand that we cannot move before your exchange has been approved and all legal documentation signed. If you move before this date, you will be classed as illegally occupying the property and legal action will be taken against you. I/We declare that the information I/we have provided on this application is, to the best of my/our knowledge, correct and that I/we have not left out any details that may affect our application. I/We understand that to give false or misleading information will result in my/our application being cancelled and I/we may be liable for prosecution under s171 of the Housing Act 1996.