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Your current Home and You - Your Current Home And You
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How many bedrooms in your current home
Five or More Bedrooms
Four Bedrooms
Three Bedrooms
Two Bedrooms
One Bedroom
No Bedroom (e.g. Hostel)
Is anyone included in this form pregnant
Yes
No
Name of person who is pregnant
Pregnancy due date
Day
Month
Year
Do you or the joint applicant provide kinship care
Yes
No
Have you or the joint applicant left, or will soon leave, the armed forces
Yes
No
Please tick if your current accommodation has any of the following problems:
Structural problems
(optional)
Yes
No
Closing order served on property
(optional)
Yes
No
Do you have the following facilities in your current accommodation?
Cold Water supply
(optional)
Yes
No
Hot Water supply
(optional)
Yes
No
Inside toilet
(optional)
Yes
No
Kitchen (bed-sit)
(optional)
Yes
No
Kitchen (recessed)
(optional)
Yes
No
Separate living room
(optional)
Yes
No
Cooking facilities
(optional)
Yes
No
Dampness
(optional)
Yes
No
Bathroom
(optional)
Yes
No
Shower room
(optional)
Yes
No
Kitchen
(optional)
Yes
No
Bedroom
(optional)
Yes
No
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