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Sunday, 20-May-2012

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>New household registration

New household registration

Household details

Household member personal details

Title:*

First name:*

Other name:

Surname:*

Date of birth:* (dd/mm/yyyy)

Sex:*

National Insurance Number:*

We keep records of the ethnic origins, sexual orientation, religious beliefs and disabilities of everyone applying for housing. This is to ensure through monitoring, that housing is provided on a fair and equal basis to all. This information is provided in confidence and will not affect your application.

Ethnic origin:

If Other selected please give details:

Is your Transgender Status the same as it was at birth?

Sexual Orientation:

Religion or Belief:

If other state:

Do you have a significant disability?*

If YES, please select disability:

Physical Disability

Learning Disability

Mental Illness

If Yes, briefly describe the disability:

Your home address

Proof needed

Address 1:*

Address 2:*

Address 3:

Address 4:

Address 5:

Postcode:*

To find an address, enter postcode and click 'search'

Date moved in to this address: (dd/mm/yyyy)

Home telephone:

Work telephone:

Mobile telephone:

Email:

Are you happy for us to contact you at this address? yes no

Current landlord

If you rent your home from a council or housing association in Leicestershire please select your landlord:

Correspondence address details

Same as current address? yes no

If yes, then please ignore the following address fields

Address line 1:*

Address line 2:*

Address line 3:

Address line 4:

Address line 5:

Postcode:*

To find an address, enter postcode and click 'search'

Email:

Correspondence telephone: