1. 2. 3. 4. 5. 6. I hereby give permission for Solo Housing (East Anglia Ltd) to contact my previous housing providers/landlords to seek information on my housing history and arrears (if applicable). Signed Date …………………………………………………………… ………………………. 5. LOCAL AUTHORITY WAITING LIST a. Registered b. Not Registered Advised to Register Not Applicable Time in area: years months weeks 6. ABOUT YOURSELF Do you have any children YES / NO (if yes state age and gender): Arrangements for access: Do you have any pets YES / NO (if yes state what): Do you smoke YES / NO you live in a smoking household Could you live in a non-smoking household YES / NO YES / NO 7. NEXT OF KIN (Only in case of emergency) Name: Relationship: Address: Postcode: Telephone: (include STD code) 8. YOUR HEALTH Please list any illnesses or allergies you have: Please list any medication (and the dosage) you are taking: Are you registered disabled YES / NO If yes, please give details:
1. 2. 3. 4. 5. 6. I hereby give permission for Solo Housing (East Anglia Ltd) to contact my previous housing providers/landlords to seek information on my housing history and arrears (if applicable). Signed …………………………………………………………… Date ………………………. 5. LOCAL AUTHORITY WAITING LIST a. Registered b. Not Registered Advised to Register Not Applicable Time in area: years months weeks 6. ABOUT YOURSELF Do you have any children YES / NO (if yes state age and gender): Arrangements for access: Do you have any pets YES / NO (if yes state what): Do you smoke YES / NO you live in a smoking household YES / NO Could you live in a non-smoking household YES / NO 7. NEXT OF KIN (Only in case of emergency) Name: Relationship: Address: Postcode: Telephone: (include STD code) 8. YOUR HEALTH Please list any illnesses or allergies you have: Please list any medication (and the dosage) you are taking: Are you registered disabled YES / NO If yes, please give details:
Application%20Pack%20Norfolk.docx