Under-occupancy 
Application form

Name of tenant/s		…………………………………………………………………..

Address 			………………………………………………..…………………

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Telephone number 	…………………………………………………………………..

Email address: 		……………………………………………………….

Type of property – 
(Please tick relevant box)

Bedsit /Studio	[ ]	Flat	[ ]	 Maisonette	[ ]	House		[ ] 

Older Peoples Housing	[ ]	 Bungalow	[ ]	 Sheltered	[ ]

Number of bedrooms your current property has		…….

Number of bedrooms you would like to downsize to	……. 

If your current property has any adaptations please indicate what they are.

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If you require any adaptations please explain what you feel you need (you may be required to fill out a self assessment medical form at a later date).

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Names of everyone (non tenancy holders) who permanently resides with you (include the ages of any children).

Person 1	……………………..		Person 2	………………………….

Person 3	……………………..		Person 4	………………………….

If you would like to elaborate further on anything, please do so here.

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Declaration

(Please delete appropriate word where there is an option)

I/we declare that the information given on this application is correct. 

I /we understand that funds for the grant are very limited and there is no guarantee I will receive a payment even if I / we are eligible for one. 

I am/we are interested in downsizing my/our current council owned property, and, if found eligible, I/we may be entitled to a downsizing grant payment. 

I/we understand that if we receive a payment and then do not move the money will need to be paid back. 

You: Signed			……………………………….	Date	………………..

Joint tenant: Signed	……………………………….	Date	………………..