LYHA | Fastpath Application

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Fastpath Application

We are processing your application.

This is a primary-stage application form. Once you place a bid on an available property and are at the point where we have shortlisted you for a home, we will ask for further information. Please ensure all the information you enter is correct at the time of making the application. Any information found to be false or inaccurate will invalidate your application.

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Main Applicant

TitlePlease enter a Title

First Name*Please enter a forename

Last Name*Please enter a surname

AddressPlease enter at least one line of address

Post CodePlease enter a postcode

Date of Birth*

Please enter a date of birth

What is your ethnic group? *

The purpose of this question is to help us to discover whether people are treated fairly when they apply for housing. The information gathered from this question will be used to help us to fight racial discrimination and improve the quality of our services. If you do not wish to answer this question, you can choose to refuse.

Please select an ethnic group

How do you describe yourself? *

Male

Female

Other

Please select a gender

EmailPlease enter a valid email address

PhonePlease enter a valid UK phone number

National Insurance Number*Please enter a National Insurance NumberDo not leave any spaces e.g. QQ123456C

Do you have any physical or mental health conditions or illness lasting or expected to last 12 months or more? *

The Equality Act defines a disabled person as someone who has a physical or mental impairment that has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities.

Yes

Prefer not to say

What is your faith? *Please enter your faith

What is your sexual orientation? *Please enter your sexual orientation

Is this a joint application?

Yes

Joint Applicant

TitlePlease enter a Title

First Name*Please enter a forename

Last Name*Please enter a surname

Address (if different to main applicant)Please enter at least one line of address

Post CodePlease enter a postcode

Date of Birth*

Please enter a date of birth

What is their ethnic group? *

How do they describe themselves? *

Male

Female

Other

EmailPlease enter a valid email address

PhonePlease enter a valid UK phone number

National Insurance Number*Please enter a National Insurance NumberDo not leave any spaces e.g. QQ123456C

Do they have any physical or mental health conditions or illness lasting or expected to last 12 months or more? *

Yes

Prefer not to say

What is your faith? *Please enter your faith

What is your sexual orientation? *Please enter your sexual orientation

Relationship to main applicant*

Is there anyone else living with you?

Yes

Other Occupants

Occupant 1

TitlePlease enter a Title

First Name*Please enter a forename

Last Name*Please enter a surname

Same Address*

Yes

AddressPlease enter at least one line of address

Post CodePlease enter a postcode

Date of Birth*

Please enter a date of birth

What is their ethnic group? *

How do they describe themselves? *

Male

Female

Other

Do they have any physical or mental health conditions or illness lasting or expected to last 12 months or more? *

Yes

Prefer not to say

Relationship to main applicant*

Anyone Else?

Yes

Occupant 2

TitlePlease enter a Title

First Name*Please enter a forename

Last Name*Please enter a surname

Same Address*

Yes

AddressPlease enter at least one line of address

Post CodePlease enter a postcode

Date of Birth*

Please enter a date of birth

What is their ethnic group? *

How do they describe themselves? *

Male

Female

Other

Do they have any physical or mental health conditions or illness lasting or expected to last 12 months or more? *

Yes

Prefer not to say

Relationship to main applicant*

Anyone Else?

Yes

Occupant 3

TitlePlease enter a Title

First Name*Please enter a forename

Last Name*Please enter a surname

Same Address*

Yes

AddressPlease enter at least one line of address

Post CodePlease enter a postcode

Date of Birth*

Please enter a date of birth

What is their ethnic group? *

How do they describe themselves? *

Male

Female

Other

Do they have any physical or mental health conditions or illness lasting or expected to last 12 months or more? *

Yes

Prefer not to say

Relationship to main applicant*

Anyone Else?

Yes

Occupant 4

TitlePlease enter a Title

First Name*Please enter a forename

Last Name*Please enter a surname

Same Address*

Yes

AddressPlease enter at least one line of address

Post CodePlease enter a postcode

Date of Birth*

Please enter a date of birth

What is their ethnic group? *

How do they describe themselves? *

Male

Female

Other

Do they have any physical or mental health conditions or illness lasting or expected to last 12 months or more? *

Yes

Prefer not to say

Relationship to main applicant*

Anyone Else?

Yes

Occupant 5

TitlePlease enter a Title

First Name*Please enter a forename

Last Name*Please enter a surname

Same Address*

Yes

AddressPlease enter at least one line of address

Post CodePlease enter a postcode

Date of Birth*

Please enter a date of birth

What is their ethnic group? *

How do they describe themselves? *

Male

Female

Other

Do they have any physical or mental health conditions or illness lasting or expected to last 12 months or more? *

Yes

Prefer not to say

Relationship to main applicant*

Anyone Else?

Yes

Occupant 6

TitlePlease enter a Title

First Name*Please enter a forename

Last Name*Please enter a surname

Same Address*

Yes

AddressPlease enter at least one line of address

Post CodePlease enter a postcode

Date of Birth*

Please enter a date of birth

What is their ethnic group? *

How do they describe themselves? *

Male

Female

Other

Do they have any physical or mental health conditions or illness lasting or expected to last 12 months or more? *

Yes

Prefer not to say

Relationship to main applicant*

Do you have a Bank Account? *

Yes

Please select whether you have a bank account.

Do you have any support workers or family members assisting you? *

Is there anyone or an organisation you wish to give permission to act on your behalf?

Yes

Please select whether you have any support.

Support worker or family member details

Please provide the name and contact details of any support workers or any family member assisting you.

Is anyone in the household pregnant? *

Yes

Please select whether anyone in the household is pregnant.

Details of any pregnant member of the household

Please provide details of any pregnant household member - Name, when is the baby due?

Do you have any pets? *

Yes

Please select whether you have any pets.

What is your total household income? *

Please enter an approximate figure, including any benefit payments you receive.

£ Please enter your household income

Is the above figure a weekly, monthly or an annual amount? *

Annual

Monthly

Weekly

Please select whether the above figure is weekly, monthly or annually.

Do you or anyone moving with you, have debts to any Council or Housing Association? *

Yes

Please select whether you have any debts to any Council or Housing Association.

Have you or anyone moving with you got any unspent criminal convictions? *

Yes

Please select whether you or anyone moving with you have any unspent criminal convictions

Is English your first language? *

We ask this question because we can provide translation services if necessary.

Yes

Please select whether English is your first language.

If we write or speak to you in English will you understand what is said? *

Yes

Please select whether you understand English

What is your language? *

If you cannot understand English. What language do you speak?

Supporting Doumentation

Proof of identification *

Such as, passport, immigration documentation, driving licence, birth certificate Files must be less than 10 MB.

Allowed file types: gif jpg jpeg png pdf doc docx.

Proof of residency *

Confirmation of details *

By confirming the details on this application: You consent to information in this application being used to detect and/or prevent fraud. You agree to the information given in this form being held and processed in computer and other records. Agree to LYHA verifying the information on this form at anytime, we may check it with, or pass it on to, organisations such as; Police/Local Authorities/Current and former landlords/GPs and other medical practitioners/Hospitals/ Banks and building societies/Credit reference agencies and other relevant organisations for the purpose of assessing your application for housing. Agree to allow LYHA to carry out an affordability check of your household via our online tool Insight. If any of the information you give on this form or from references is false or wrong, we may reject your applications. If we find out after you have been given a home, we make take steps to re possess the property.

I (the main applicant) confirm that the information given in this form is true and complete. Please confirm

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Leeds and Yorkshire Housing Association

Leeds and Yorkshire Housing Association
3rd Floor White Rose House
8 Otley Road
Headingley
Leeds
LS6 2AD
Tel: 0113 278 3335
Email: info@lyha.co.uk