SHAREHOLDING MEMBERSHIP OF THE
ASSOCIATION APPLICATION FORM
Data Protection Act 1998: Information provided by you on this form will firstly be used to assess suitability for Shareholding membership and should your application be successful, would be stored throughout the duration of your shareholding so that we can send you invitations for such events as our AGM, and any associated papers.
Should you wish to request a copy of your personal information that is held by us, please request this in writing to the Company Secretary.
Notes on Shareholding Membership
1 Please enclose £1 with your application, which will be returned if your application is not successful
2 All tenants and residents of Broadland Housing Association shall be entitled to become a shareholder of the Association subject to:
o Being named on the tenancy agreement or licence.
o Not being more than one month in arrears on both the date of the application and on the date that the appropriate committee, as designated by the Board, consider the application. The arrears will not take account of housing benefit arrears
o Not being subject either to an Anti-Social Behaviour Order (ASBO) within the previous 12 months, or a notice of intention to seek possession for anti-social behaviour
o Agreeing to the Association’s objects as stated in section A2 of the governing Rules
The Association will check its tenant records to ensure that the above criteria are met before processing applications received from Broadland Housing Association tenants.
3 Section A2 of the governing Rules states that all shareholders must act in the interests of the Association at all times and, for the benefit of the community, as guardians of the objects of the Association. A copy of the Rules will be made available to all applicants.
4 No employee of a Broadland Housing Group entity can become a BHA shareholder.
In accordance with section C6.3 of the governing Rules, paid employees may not be granted shareholding membership of the Association. This restriction applies to
employees of all entities within Broadland Housing Group. Employees may, however, attend meetings in their professional non-voting capacity.
1. Personal Details
(a) Title: Mr / Mrs / Ms / Miss / Other (*delete as applicable. If other, please specify)
(b) Name:
(c) Decorations, etc:
(d) Home address (inc Post Code):
(e) Date of Birth:
(f) Telephone: (Home)...... (Work)
(Mobile)......
(g) Email address: ...
(h) Occupation:
Full time / Part time (please delete as appropriate)
2. Are you a tenant of Broadland Housing Association? YES / NO
Are you a Meridian East service user? YES / NO
3. Paid Employees:
Are you a paid employee of the Association? YES / NO
4. Qualifications and Experience (optional for tenant applicants)
(a) Qualifications
(b) Experience
(please use a separate sheet if necessary)
5. Association Membership
(please give brief reasons why you wish to become a member of the Association).
6. Conflict of Interest
It is generally illegal for members, past members or their close relatives or cohabitees to receive any gift or any payment (bonus or dividend) from the Association.
If a member belongs to a company or business trading for profit, that company or business is similarly barred (see Section 122 of the Housing and Regeneration Act 2008).
For Board and Committee members, there are further financial restrictions.
You are therefore required to declare any interest you or a member of your family or your cohabitee holds (e.g. business ownership or management of a business) which might benefit from your membership, and you must inform the Association if any other such interest arises at any time.
(a) Any such interest of your own:
(b) Any such interest of any spouse/partner/cohabitee:
7. If you have a disability or otherwise, are there any arrangements that would make things easier for you?
8. Rules
I declare that I will abide by the Rules of the Association (please see note 3 on p1).
Signature
Date
NB: Please enclose £1 with your application,
which will be returned should it not be accepted
EQUAL OPPORTUNITIES FORM
Broadland Housing Association operates an equal opportunities policy. To help us monitor its effectiveness, please complete the following sections and return it with the application form.
DATA PROTECTION
Broadland Housing Association is legally required to demonstrate that it is providing its services fairly to everyone regardless of their sex, race or any disability.The information we want to collect from you (called “Data”) will include details of your date of birth, gender, ethnic origin, disability, sexual orientation and religion. The Data comprises Personal Data and/or Sensitive Personal Data as defined under the Data Protection Act 1998. Broadland Housing Association will only use the Data for:
(i) monitoring the constitution of its Board structure
(ii) future development of equality strategies and services to meet identified need
Unless required to do so by law and with the exception of disclosure to The Tenant Services Authority, Broadland Housing Association will not disclose the Data to any third party without your prior consent.
You are also entitled, after you have provided the Data, to ask Broadland Housing Association to amend or to stop using the Data. If this is the case, you should inform your housing association staff.
Do you give your explicit consent to the processing of the Data?
Yes / No/
Date /
Signature
DATE OF BIRTH:
GENDER: / Female / Male
MARITAL STATUS:
Single (never married) / Married / Re-married
Separated (but still legally married) / Divorced / Widowed
Civil Partnership
ETHINIC ORIGIN:
What is your ethnic group? Choose ONE section from A to F, then tick the appropriate box to indicate your cultural background
A / White
British / English
Scottish
Welsh
Other, please specify
Irish
Other White background, please specify
B / Mixed
White and Black Caribbean
White and Black African
White and Asian
Other Mixed background, please specify
C / Asian or Asian British, Asian English, Asian Scottish, Asian Welsh
Indian
Pakistani
Bangladeshi
Other Asian background, please specify
D / Black or Black British, Black English, Black Scottish, Black Welsh
Caribbean
African
Other Black background, please specify
E / Chinese or other ethnic group
Chinese
Any other background, please specify
F / Travellers and Gypsies
Romany gypsy
Irish traveller
Other traveller/gypsy background, please specify
DISABILITY DISCRIMINATION ACT 1995:
Do you consider that you have a disability or condition within the definition of the Act? / Yes / No
Please tell us which of these best describes your disability: / Hearing impairment
Visual impairment (not corrected by spectacles or contact lenses)
Speech impairment
Mobility impairment
Physical co-ordination difficulties (includes problems of manual
dexterity and of muscular control e.g. incontinence, epilepsy)
Reduced physical capacity (includes debilitating pain and lack of strength,
breath, energy or stamina e.g. from asthma, angina or diabetes)
Severe disfigurement
Learning disabilities
Mental illness (includes substantial and long lasting – more than a year)
Progressive conditions e.g., MS, HIV, Cancer
Other, please specify
If yes, are there any arrangements we could make for you. Please give details:
RELIGION:
Church of England / Catholic / Protestant / Other ChristianSikh / Jewish / Buddhist / Hindu
Muslim / None / Other,
please specify
SEXUAL ORIENTATION:
Heterosexual / Gay man / Lesbian / Bi-sexual
Other, please specify