The details you provide in this section help us match this form to your application and so you should tell us here the details from your original application– for example
If you’re changing your name tell us here the name we have recorded for your application not your new name. If you’re changing your address please tell us the address you have just moved from and not your new address.
You will get a chance in section 2 to tell us about the changes to your application.
Housing application number *
BERN
Title *
Please Select
Mr
Mrs
Miss
Ms
Dr
Exor
Mstr
Rev
Other
First Name *
Last Name *
Please tell us the address we have recorded for your application *
Date of Birth *
National Insurance Number *
If you supply us with a mobile phone number or email address this will be our method of contact with you.
Phone Number
Mobile Number
Email Address
In this section we will ask you what part of your application you want to update. You must answer all of the questions before you will be able to submit your form.
Do you want to tell us about a change of address?
Please Select
Yes
No
Please tell us your new address *
When did you move into this address *
What type of property is your new home? *
Please Select
House
Bungalow
Ground floor flat
Upper flat
Maisonette
Bedsit
Hostel
Prison
Hospital
No fixed address
Other
Please give details
At your current address are you one of the following *
Please Select
Owner
BMBC tenant
Private tenant
Other Council tenant
Housing Association tenant
Lodger
Prison
Hospital
Hostel
Bed and breakfast
Street Caravan / tent
Landlords Name
Landlords Name
Landlords Name
Landlords Address
Landlords Address
Landlords Address
Landlords Phone Number
Landlords Phone Number
Landlords Phone Number
How many bedrooms are there in the property? *
Please Select
1
2
3
4
5 or more
Bedsit
Landlords name (please note we will contact your landlord for a reference). *
Landlords address (please note we will contact your landlord for a reference). *
Landlords phone number *
Does anyone else live at your new address (this includes any people moving with you and those not moving with you) *
Please Select
Yes
No
Additional occupants
Why are you still seeking rehousing after your move? *
Is there an existing joint applicant? *
Please Select
Yes
No
Title *
Please Select
Mr
Mrs
Miss
Ms
Dr
Exor
Mstr
Rev
Other
First Name *
Last Name *
Date of Birth *
National Insurance Number *
Do you want to add a joint applicant to your application *
Please Select
Yes
No
Tell us about the person you want to add as a joint applicant
Title *
Please Select
Mr
Mrs
Miss
Ms
Dr
Exor
Mstr
Rev
Other
First Name *
Last Name *
Date of birth *
Address *
National Insurance number *
What is their gender?
Please Select
Male
Female
How would they describe their ethnic origin
Please Select
White British
White Irish
Any other white background
Mixed white and black Caribbean
Mixed white and black African
Mixed white and Asian
Any other mixed background
Indian
Pakistani
Bangladeshi
Asian British
Any other Asian background
Black Caribbean
Black African
Black British
Any other black background
Chinese
Gypsy Traveller
Gypsy Romany
Any other ethnic group
Prefer not to say
Don't know
What is their first language
Please Select
English
Albanian
Farsi
Polish
Hindi
Russian
French
Urdu
Spanish
Bengali
Punjabi
Chinese
Arabic
Other
If other, please give details
What is their faith
Please Select
Christian
Buddhist
Jewish
Sikh
Muslim
Hindu
Rastafarian
No religion
Prefer not to say
Other
If other, please give details
Do they consider themselves disabled
Please Select
Yes
No
If yes, please tick all that apply
Hearing problem
Sight problem
Speech problem
Use a wheelchair
Mental-health problem
Need help to walk
Almost unable to walk
Learning disability
If we get in touch with you, do you need any of the following?
Please Select
Large Print
Sign Language
Braille
Audio tape or CD interpreter
Please specify language
Language required:
If we visit you, should we do any of the following?
Please Select
Knock Loudly
Use the back door
use the side door
Wait to be let in
Use the front door
Make a special appointment
If we have to make a special appointment to visit you, should we:
Make the appointment with a key worker (for example, social worker)?
Please Select
Yes
No
Name and Contact details:
Make the appointment with someone who has the power of attorney for you?
Please Select
Yes
No
Name and Contact details:
How would you describe your sexuality?
Please Select
Heterosexual or straight
Bisexual
Gay woman or lesbian
Gay man
Other
Prefer not to say
Do they live with you? *
Please Select
Yes
No
When did they start living with you? *
Where did they live before? *
Where do they live?
When did they move in here?
And are they?
Please Select
Tenant
Owner
Lodger
Have they lived anywhere else in the last five years?
Please Select
Yes
No
Where else have they lived in the last five years?
We can refuse to give you access to the housing register if you or a member of your household have been involved in criminal or antisocial behaviour. If you want us to consider the joint applicant, you must say whether they have been involved in or convicted of any of the following activities:
Does your joint applicant have any of the following criminal convictions (tick all that apply)
Murder / manslaughter
Firearms / weapons
Using or possession of drugs (or both)
Intimidating or harassing neighbours, other residents or our employees
Supplying drugs
Theft or damage to our property or another property owned by a landlord
Burglary or theft from homes, motor vehicles and so on
Racial harassment
Sexual offences or indecent offences
Arson
Assault (verbal or physical)
Being evicted for unpaid rent from council, housing association or other landlord owned property
Being evicted for noise or other nuisance from council, housing association or other landlord owned property
Antisocial Behaviour
Benefit or tenancy fraud
Any other convictions (apart from minor traffic offences)
If yes to any of the above, please list convictions
Please Select
Yes
No
Convictions
If yes, what are their contact details?
Do you want to add anyone else to your application?
Please Select
Yes
No
If you are currently pregnant then you will need to let us know the full name and date of birth once the baby arrives. You can tell us by completing our online Homeseeker contact form or you can write to us at Berneslai Homes Assessment Team, PO Box 627, Barnsley, S20 9FZ.
Extra people
If adding a baby you will have to provide a copy of the birth certificate to Assessments, PO Box 627, Barnsley, S20 9FZ
Do you want to remove someone from your application
Please Select
Yes
No
To remove
Do you want to change the property type you want to be rehoused in
Please Select
Yes
No
What type of property do you want
House
Bungalow
Upper-floor Flat
Upper-floor Flat (with lift)
Ground-floor flat
Maisonette
Bedsit
Extra care
Smithies Lane caravan site
How many bedrooms do you need?
Please Select
1
2
3
4
5 or more
Bedsit
Please note that we only have a limited number of 5 bedroom properties
Do you want to change the areas you want to be rehoused in?
Please Select
Yes
No
Change the areas I am interested in being rehoused in
Please tick all the areas below that you are interested in
Aldham House Estate
Ardsley
Athersley North
Athersley South
Barugh Green
Billingley
Birdwell
Blacker Hill
Bolton on Dearne
Brierley
Broadway
Burton Grange
Carlecoates
Carlton
Cawthorne
Crane Moor
Crow Edge
Cubley
Cudworth
Cundy Cross
Darfield
Darton
Dodworth
Dunford Bridge
Elsecar
Gawber
Gilroyd
Goldthorpe
Great Houghton
Green Moor
Grimethorpe
Hemingfield
High Hoyland
Higham
Highgate
Honeywell
Hood Green
Hoyland
Hoyland Common
Hoylandswaine
Ingbirchworth
Jump
Kendray
Kexborough
Kingstone
Little Houghton/Middlecliffe
Lundwood
Mapplewell
Millhouse Green
Monk Bretton
New Lodge
Oxspring
Penistone
Pilley or Tankersley
Platts Common
Redbrook
Royston
Shafton
Silkstone
Silkstone Common
Smithies
Staincross
Stairfoot
Thurgoland or Wortley
Thurnscoe
Thurstone
Town Centre
Ward Green
West Green
Withorpe
Wombwell
Worsbrough Bridge
Worsbrough Common
Do you want to change your name?
Please Select
Yes
No
New Name
Title *
Please Select
Mr
Mrs
Miss
Ms
Dr
Exor
Mstr
Rev
Other
First Name *
Surname *
Previous Name
Title *
Please Select
Mr
Mrs
Miss
Ms
Dr
Exor
Mstr
Rev
Other
First Name *
Last Name *
Reason for change *
Please Select
Marriage
Change to maiden name
Changed by deed poll
Other
If other, please give details
Under the new policy, those who have the ability to resolve their own housing issues may be excluded from the register or have their priority reduced.
Are you employed?
Please Select
Yes
No
What is your income?
What is your and any joint applicant's total YEARLY income (before outgoings)?
Do you own property?
Please Select
Yes
No
What is the approximate value?
Amount mortgage outstanding?
Have you ever gifted property?
Please Select
Yes
No
Please provide details
What is your current amount of savings/investments?
Are you currently on Universal Credit / Housing Benefit?
Please Select
Yes
No
Have you been served a Notice to Quit?
A Notice to Quit is a letter from your landlord telling you that your tenancy is going to end and you will need to contact the Housing Options, Advice and Homeless Prevention Service on (01226) 773870 who will provide further advice and assistance.
Please Select
Yes
No
If yes what date do you have to leave?
Please tell us about any other change in circumstances
Use this section to upload information that may help us deal with your change of circumstances. For example a landlord reference, a birth certificate or a proof of pregnancy.
To upload this information you can either use a scanner or take a photo with your phone or tablet. Just click the upload button.
More than one piece of information? Just click the “Add” button after you’ve finished uploading each one. You can upload a maximum of five pieces of evidence.
If you haven’t got the evidence to upload at this point you can save your form until you have or you can upload it later using our “Document upload e form” which you can find on the Tell Us About it section of our website.
Documents of proof
By ticking the box below, I declare that I fully understand and agree with the following statements:
- I declare that the information I have given on this form is correct and complete.
- I understand that if you later find that I have deliberately supplied false information or omitted to supply information, this can affect my rights to a tenancy and you may take action against me if I am granted a tenancy.
- I understand that if I have not completed this form fully it may result in a delay in us acting on your request.
- I understand you may share my information with other agencies to detect and prevent fraud.
- I confirm and understand that if I am in rented accommodation that you will contact my landlord for a reference.
I confirm