Application form for a plot on the Chilmington Gypsy and Traveller Site.

Applicant Name *

Date of Birth *

National Insurance Number *

Are You Working? *

Yes
No

Please list any benefits you are collecting *

Contact Telephone Number *

Household Details

Please provide the full names of all the people who will live on the site with you.

Names of other persons *

Please provide details of any medical conditions or any disability that affects you or your household that is made worse by your current living circumstances *

Are there any welfare issues that we should take into account when considering your application? *

Where do you live at the moment? *

Do you have to leave this accommodation for any reason? Give details. *

Are you travelling at the moment or parked on land without permission? If so where? *

Do you currently rent or own any other plot or accommodation? If so give details and provide a copy of any tenancy agreement / details of current landlord *

Have you or a member of your household: Been convicted for violence? Been convicted for drug dealing or drug use? Been involved in any previous allegations of anti social behaviour or threatening behaviour? Please provide details: *

Please provide full details including the area that the incident happened in and any sentence issued. *

Do you have any pets or animals? Please provide details. *

Do you have any family connections on the Chilmington Site – please provide details. *

Have you applied anywhere else e.g. to the Kent Gypsy Unit for other Kent sites or to another council or any other accommodation provider? Please provide details. *

Have you ever lived on Chilmington previously or any other managed site – provide details of plot number / address and dates together with manager details. *

Please give details of any other property that could be lived on or in other than your current home. *

Is there anything else that you need to tell us about your circumstances or accommodation that may be relevant to your application? *

Declaration *

Spam guard