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Where applicable please supply the following landlord information - No reference request will be sent without your express consent.
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Please note that the charity may wish to see supporting documents to confirm the details of your application. These documents may include bank, benefit, rent or mortgage statements, utility bills etc. We will contact you if they are required.
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Data Consent Form
If you, or someone on your behalf, completes this application form an electronic and/or paper file will be opened for you which will contain information within this form and any subsequent correspondence with you, your doctors, referees or others such as advice workers, social workers and public authorities. The file(s) will also contain the reports of any visits made to you and details of any assistance provided including monies and goods.
The files will be kept securely and in strict confidence and will not be passed to any other individual or organisation without your consent, except where required to do so by law.
You have the right to request a copy of your file(s) except for any information held within them about another person. A charge of £5 will be made for a copy. Your file(s) will be destroyed six years after you last receive support.
I - the applicant - Declare that the information provided in this form is true and accurate to the best of my knowledgeand belief. In addition I authorise the charity to contact my referees. I understand that once an offer has been made this offer will only be subject to satisfactory references from your current landlord. I have read, understand and agree to the National Benevolent Charity maintaining file(s) with information about me and sharing that information with other bodies as set out above.