Register of Interest Form

Main applicant's title (Mr, Mrs etc.) *

Main applicant's forenames *

Main applicant's surname *

Joint applicants title

Joint applicants forenames

Joint applicant's surname

Number of children in the household

Address name/number

Street

Village

County

Postcode

Telephone number

Email address

Date of birth

Village applying for *

Local Connection Criteria *

I currently live in the village/parish
I used to live in the village/parish
I work in the village/parish
I have close relatives in the village/parish

Please give further details regarding your connection to the village e.g. how long you have lived/worked in the Village/Parish, any close relatives who live in the Village/Parish. *

Do you wish to:

Number of bedrooms required

Property required

Current tenure

Why are you applying for housing

Security check

Find a home

PDRHA Register of Interest Form