Housing Application Form Page 4
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175 Please give details of all the people who will be living with you permanently
when you move.
Sex:
First name
Last name
Date
Address, if
Relationship
Ethnic
male or
of
different
to you
code
female
birth
from yours
(see pg. 3)
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6 Is anyone in the household pregnant?
Yes
No
If 'Yes', who? _______________________________________
When is the baby due to be born? _____ / _____ / _____
Please provide proof of your pregnancy (for example, a copy of your maternity record
booklet).
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7 If you need housing because you or your partner has access to children from
a previous marriage or relationship,
please provide details of your children and how
often they stay with you in the space below. Please provide documents to confirm this.
Names of the children and their
How often do the children stay with you or
relationship to you or your partner
your partner? How many nights do they
stay?
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