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.

Main Applicant

Please enter a Title
Please enter a forename
Please enter a surname
Please enter at least one line of address
Please enter a postcode
Please enter a date of birth

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
Please select a gender
Please enter a valid email address
Please enter a valid UK phone number
Please enter a National Insurance NumberDo not leave any spaces e.g. QQ123456C

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.

Joint Applicant

Please enter a Title
Please enter a forename
Please enter a surname
Please enter at least one line of address
Please enter a postcode
Please enter a date of birth

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 enter a valid email address
Please enter a valid UK phone number
Please enter a National Insurance NumberDo not leave any spaces e.g. QQ123456C

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.

Other Occupants

Occupant 1

Please enter a Title
Please enter a forename
Please enter a surname
Please enter at least one line of address
Please enter a postcode
Please enter a date of birth

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.

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.

Occupant 2

Please enter a Title
Please enter a forename
Please enter a surname
Please enter at least one line of address
Please enter a postcode
Please enter a date of birth

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.

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.

Occupant 3

Please enter a Title
Please enter a forename
Please enter a surname
Please enter at least one line of address
Please enter a postcode
Please enter a date of birth

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.

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.

Occupant 4

Please enter a Title
Please enter a forename
Please enter a surname
Please enter at least one line of address
Please enter a postcode
Please enter a date of birth

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.

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.

Occupant 5

Please enter a Title
Please enter a forename
Please enter a surname
Please enter at least one line of address
Please enter a postcode
Please enter a date of birth

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.

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.

Occupant 6

Please enter a Title
Please enter a forename
Please enter a surname
Please enter at least one line of address
Please enter a postcode
Please enter a date of birth

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.

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.

Please select whether you have a bank account.

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

Please select whether you have any support.

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

Please select whether anyone in the household is pregnant.

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

Please select whether you have any pets.

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

£ Please enter your household income
Please select whether the above figure is weekly, monthly or annually.
Please select whether you have any debts to any Council or Housing Association.
Please select whether you or anyone moving with you have any unspent criminal convictions

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

Please select whether English is your first language.
Please select whether you understand English

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

Supporting Doumentation

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.

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.