This form will take around 15 minutes to complete and you will not be able to save and come back later. You do have the option to print the form and post it back to us if you prefer.
About You
About Your Family
About Your Home
Your Income
Health and Social
References
Declaration
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Please give details of any occupations you have followed and for how long. Any present occupations should be included:
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Please give the name and address of your Landlord
Please complete all sources of income and how regularly you receive them. Leave fields blank if they are not relevant to you:
Please give the names and addresses of two responsible people (not relatives) who know you well and whom the charity may approach for a character reference.
I have read the charity’s Conditions of Entry and believe that I am eligible to apply to live in one of the charity’s almshouses. I declare that the information given in this application is correct and complete to the best of my knowledge and belief.
I accept that if I am appointed as a resident I shall be a Licensee of the charity and not a tenant. Any weekly sum I pay will be a maintenance contribution and not a rent. If elected agree to abide by the rules governing the Almshouses. I confirm that I am able to look after myself, with the assistance of family and social services if necessary.
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