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Home telephone:

mobile:

email:

Home address:

How long have you lived at this address?

Full name of applicant:

Date of birth:

List all other addresses lived at in the last five years:

Living with partner

Civil Partnership

Male

Female

Single

Married

Separated

Divorced

Widowed

Names/dates of birth of all other ADULTS & CHILDREN living in the same household and their RELATIONSHIP to the applicant:

Are you listed on an UK electoral role?

If yes, for which area? (Uxbridge, Harefield, Hillingdon, Hayes, Ickenham, Ruislip, West Drayton etc)

No Yes Employment status:

. If unemployed, when did you last have paid work?

National Insurance Number:

If not UK national what status the UK?

Nationality:

WHO OWNS THE PROPERTY YOU LIVE IN?

(Please choose from the types below)

Rent paid AFTER housing benefit

The London Borough of Hillingdon and the tenancy is temporary

permanent

£

A housing association and the tenancy is temporary

permanent

£

A private landlord or student accommodation and the tenancy is for .............................. months

£

Do you pay your water rates separately to your rent? Yes

No

If yes state the amount you pay for your water rates £

For owner

Who owns the property? The applicant; applicant’s parents; a friend; relation;

Amount of monthly mortgage if

occupiers only

other please state:

applicable £

Are you the owner, co-owner, part owner, time-share owner or tenant

If yes please provide details on a separate sheet of paper

of any other property, either here in the UK or abroad? YES

No

List your total WEEKLY INCOME including all state benefits received or any you have applied for and are waiting to hear about.

Do you have any SAVINGS?

Do you claim a PRIVATE PENSION i.e. one not provided by the state (if yes give details)

No

Yes

how much?

No

Yes

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(UUWT) GRANT APPLICATION FORM ©SP 02/11 (v10)

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