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
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?
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
A housing association and the tenancy is temporary
A private landlord or student accommodation and the tenancy is for .............................. months
Do you pay your water rates separately to your rent? Yes
If yes – state the amount you pay for your water rates £
Who owns the property? The applicant; applicant’s parents; a friend; relation;
Amount of monthly mortgage if
other – please state:
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
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)
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(UUWT) GRANT APPLICATION FORM – ©SP – 02/11 (v10)