Applicant Number One
Title *
First Name *
Surname *
Other Names
Date of Birth
Day:
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
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30
31
Month:
01 02 03 04 05 06 07 08 09 10 11 12
Year:
1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Telephone *
Mobile
Email *
Residential Status
Property Owner
Council Tenant
Private Tenant
Living with Friends/Relatives:
No
Yes
Have you any county court judgements, court decrees, bankruptcy, or administration orders?
No
Yes
Judgement Info Judgements Information
Applicant Number One
Employment Status
Employed
Unemployed
Retired
Self Employed
Student
Independent Means
On Contract
Company Name *
Company Contact Name *
Address line 1 *
Address line 2 *
Postcode *
Telephone
Fax
Email
Salary
Payroll/Service/Pension Number
Position Held
Start date
Day:
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month:
01 02 03 04 05 06 07 08 09 10 11 12
Year:
1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Is this position permanent?
No
Yes
Will your employment change before the proposed tenancy starts?
No
Yes
Applicant Number One
Employment Status
Employed
Unemployed
Retired
Self Employed
Student
Independent Means
On Contract
Company Name
Address line 1
Address line 2
Postcode
Telephone
Fax
Email
Salary
Payroll
Position Held
Start date
Day:
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month:
01 02 03 04 05 06 07 08 09 10 11 12
Year:
1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
End date
Day:
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month:
01 02 03 04 05 06 07 08 09 10 11 12
Year:
1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
I
hereby confirm that the information provided by me is to the best of my knowledge true. I consent to this information being verified by contacting third parties detailed in this form. I understand that the results of the findings will be forwarded to the appointed agent and/or landlord and may be accessed again should I default on my rental payment or apply for a new tenancy agreement in the future. I agree that Ultimate Homes & Finance or their approved agent may search the files of a Credit Reference Agency, the insurance industry's data collection agency, which will keep a record of that search. I understand that I may request the name and address of the Credit Reference Agency to whom I may then apply for a copy of the information provided.
I also understand that in the event of my defaulting on the rental payment, that any such default may be recorded with the Credit Reference Agency who may supply the information to other credit companies or insurers in the quest for the responsible granting of tenancies, insurance and credit.
I understand that in the event of any default by me in respect of the covenants in my tenancy agreement with my landlord, the information contained herein may be disclosed to Ultimate Homes & Finance and/or one or more tracing companies and/or debt collection agencies in order to recover any monies due or to trace my whereabouts. I understand that the information provided by me may be transferred to a country outside of the EU for the purposes only of processing this referencing application, notwithstanding such transfer. Ultimate Homes & Finance will remain the Data Controller for the purposes of this application. The information provided in this form by me is information as described in Ground 17 of the Housing Act 1996 and I understand that if any information within this application is found to be untrue, it is grounds for termination of the tenancy. I also understand that if any default in the payment of rent may affect any future application for tenancies, credit or insurance and that the assessment of this application presumes that at some time during the tenancy agreement, I may be granted or allowed some form of deferred payment.
Tick this box to confirm you have read and agree to the above declaration
Applicant 1 tick here as your electronic signature
