City Housing Eligibility & Application (Page 8 of 8) in pdf

City Housing Eligibility & Application Page 8

Accommodation Needs

Please explain why you require accommodation with City Housing

Do you or anyone living in your household require any particular type of accommodation to assist with a disability?

Yes

If yes, reason why

Please list your preferred areas (suburbs) below:

Number of bedrooms required

Preferred areas(suburbs)

Other facilities required

Bedsit / Studio

Garage

1 Bedroom

Wheelchair access

1 Double Bedroom

Off-street parking

No stairs

2 Bedrooms

Comments

I / we authorise City Housing, Christchurch City Council (or its agent)

1. To obtain, and any agency to disclose, a credit reference check

2. To disclose to a credit agency details of any indebtedness to City Housing

3. To obtain your forwarding address upon vacation of a City Housing property.

I / we declare that the information contained in this application is true and correct.

I / we acknowledge the right of the Christchurch City Council to check the validity of the information

supplied with regard to my application and ongoing tenancy, including medical, social, and financial where applicable.

If misleading or false, the application may be cancelled.

Applicant 1

Name (Please print clearly)

Signature

Date

Applicant 2

Name (Please print clearly)

Signature

Date

Civic Offices, 53 Hereford Street, Christchurch 8011. PO Box 73016, Christchurch 8154.

Phone: 03 941 8999, Facsimilie: 03 941 8267, Email: housing@ccc.govt.nz,

ALF01

City Housing Eligibility & Application Page 8