Innisfree Housing Association

INNISFREE HOUSING ASSOCIATION

(A charitable Housing Association)

TRANSFER APPLICATION FORM

Please complete all sections of Application Form – if you require assistance please contact your housing officer

Name of Tenant(s) ______

Current Address ______

______

Telephone:Home: ______

Work: ______

Mobile: ______

E-mail______

Next of Kin: ______

Relationship to Tenant: ______Contact Tel No. ______

1.Household to be rehoused

Full Name / Date of Birth / Relationship to Tenant / Length of residence
Tenant

Please list any members of the family not currently living with you, who you would like to be included on your application and why? (Please note, if you are expecting a child we will not consider them until after birth and we will require a copy of birth certificate).

Name / Date of Birth / Address / Relationship to Tenant

Please state reasons for applying for a transfer. Please note, if you are applying on the grounds of harassment we will require evidence e.g. Police reports, diary of incidents or other supporting evidence.

3. Details of present accommodation

What type of accommodation do you occupy?Flat Maisonette House

Which floor is your home on? ______Does it have a lift? Yes No

How many bedrooms do you have?Bedsit 1 2 3 4

Does your home have any form of heating?YesNo

If yes, please describe ______

Do you have access to a garden?YesNo

Are there any adaptations in your home (e.g. rails, ramps etc.)? Yes No

If yes, please describe ______

______

4.Details of Transfer Requirements

Social – need family or other support Medical FactorsHarassment

Please tick one and provide details;

______

Do you, or any member of your household, have any health problems which would affect your housing requirements? Yes No

If there are medical grounds, you must supply written supporting evidence from Doctor or medical practioner – see medical form

Will you need adaptations to your home? YesNoNot Sure

If so, what type? ______

B.Property Requirements

Which of the following would you consider? Flat Maisonette House

How many bedrooms do you need?1234

Please tick all floor levels on which you would be prepared to live:

With a lift: - Ground1st2nd3rd4th5th and above

Without a lift: Ground1st2nd3rd4th5th and above

Do you require Central Heating? YesNo

Do you have a pet? Yes No

Wheelchair User? Yes No

Please note that dogs will not be allowed in flats without sole use of a garden

C.Areas of Choice

Innisfree has accommodation only in the Boroughs shown below

Brent, Camden, Ealing, Enfield, Hammersmith & Fulham, Haringey, Harrow, Hertsmere, Lewisham, Lambeth, Islington, Hillingdon

Current Stock

Borough / 4 Bed House / 3 Bed House / 2 Bed House / 4 Bed Flat / 3 Bed Flat / 2 Bed Flat / 1 Bed Flat / Studio / TOTAL
Brent / 6 / 13 / 12 / 2 / 21 / 75 / 93 / 7 / 229
Camden / 2 / 1 / 0 / 8 / 19 / 18 / 33 / 0 / 81
Ealing / 1 / 4 / 0 / 0 / 0 / 0 / 0 / 0 / 5
Enfield / 0 / 0 / 0 / 0 / 0 / 24 / 0 / 0 / 24
Hammersmith & Fulham / 0 / 7 / 4 / 0 / 0 / 11 / 6 / 16 / 44
Haringey / 2 / 15 / 8 / 0 / 0 / 12 / 0 / 0 / 37
Harrow / 1 / 6 / 0 / 0 / 0 / 0 / 0 / 0 / 7
Hertsmere / 2 / 1 / 0 / 0 / 0 / 0 / 0 / 0 / 3
Hillingdon / 0 / 1 / 0 / 0 / 0 / 0 / 0 / 0 / 1
Islington / 0 / 3 / 0 / 0 / 0 / 0 / 0 / 0 / 3
Lambeth / 0 / 7 / 0 / 0 / 0 / 0 / 0 / 0 / 7
Lewisham / 0 / 2 / 1 / 1 / 1 / 0 / 0 / 5
TOTAL / 12 / 59 / 25 / 5 / 38 / 129 / 120 / 23 / 413

Please list below your 1st, 2nd and 3rd choice of area that you would consider transferring to:

1st Choice ______

2nd Choice ______

3rd Choice ______

Other choices______

D.Other Re Housing Requirements

Do you wish to move to any other part of the UK?Yes No

If yes, where would you like to move? ______

Would you like details of HOMESWAPPER? Yes No

ANY FURTHER INFORMATION

______

I confirm that the information given is correct to the best of my knowledge. I understand that by providing false information to obtain a transfer I may be committing a breach of tenancy and may lose any future home offered to me.

Signature of Applicant(s) ______

Date ______

Please return form to:Innisfree Housing Association

190 Iverson Road

London

NW6 2HL

Tel: 020 7625 1818

Banding

Band A

All supported housing Move-On tenants who have been waiting longer than 2 years and are ready to move on (A1)
Cases of harassment and domestic violence with supporting evidence(A2)
Urgent medical (A3)
Severe overcrowding defined as needing 2 or more bedrooms(A4)

Decants(A5)

Under-occupation which releases a family unit for letting to an overcrowded Innisfree tenant(A6)

Band B

Supported Housing move on tenants who have been waiting for less than 2 years and are ready to move on(B1)
Non urgent medical(B2)
Overcrowding defined as requiring an additional bedroom(B3)

Band C

Moving for social reasons e.g. to receive or provide support to/from family members, to be nearer location of work or child’s nursery and to move away from a source of nuisance(C1)
The non-dependent children of severely overcrowded families who are eligible to one offer of a bed-sit or one bed flat. Innisfree will make up to two offers per year for this category of transfer need(C2)

Band D

No transfer need(D1)

DIVERSITY AND ETHNICITY MONITORING INFORMATION

REFUSED / YES/NO
White
British
Irish
Gypsy/Romany/Irish Traveller
Other / Mixed
White and Black Caribbean
White and Black African
White and Asian
Other
Asian or Asian British
Indian
Pakistani
Bangladeshi
Other / Black or Black British
Caribbean
African
Other
Chinese or any other ethnic group
Chinese
Other
Abilities:
Do you have a Disability?
Yes or No
Can you describe this? / Language:
Is English your first language?
Yes or No
If not, what is your first language?
Communication: Have you any difficulty communicating using reading or writing?
Yes or N
Please describe / Religion: Please describe
Sexuality: Heterosexual Bisexual Gay Lesbian or Transgender
What is the best way Innisfree Housing Association may contact you?
□telephone
□postal questionnaires
□newsletters / □home visit
□website or email
□other; please state

FOR OFFICE ONLY

Arrears on rent Account?Yes No If yes, amount of arrears £______

Banding ______

Home Connection User ID______

Home Connection PIN______

Comments: ______

______

Approval Signature of Housing Director______Date ______

Letter sent to confirmDate:______

Signature of Administration Officer:______Date______

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