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Rental Application Form

Rental Application Form

Personal Details

Gender Current Housing Situation - Please include the last 6 adresses if possible
NI Number


Are you currently employed?
If yes, please state the name and address of your employer
Name Address
Position Salary
Are you in receipt of benefits?
If yes, what benefits are you in receipt of?
What is the weekly amount of benefits?
Could you raise money towards a deposit at the moment?
If yes, how much deposit do you have available for accommodation?


How would you describe your current status?
Have you any medical problems?
If yes, please give details
Do you have any convictions for any of the following?
Do you have pending convictions
Please explain, for example, nature of offence any sentance served, etc.

Housing Preferences

What are you looking for? Bedrooms needed Do you have pets?
Do you have any other requirments in relation to your accomodation?
Please state your areas of choice in order of preference
Are you currently registered with the NIHE If yes, how many points do you have?
Have you received any offers? If yes, give details
How did you hear about us? Do you have any children that will be living with you?

Family Make Up

Child One   Name DOB Sex
Child Two   Name DOB Sex
Child Three   Name DOB Sex
Child Four   Name DOB Sex

Proof of Income & References

Can you provide us with proof of income and a reference from one of the following?


Do you receive support from other services?
Please give details, for example, names, telephone numbers, and details of last contact, etc.

Smartmove Support

SmartMove offers a range of support including housing advice, help to find good quality affordable accommodation, support to set up your housing benefit claim, tenancy support provided by dedicated tenancy support officers, and mediation.
Do you feel you require any additional support in your accommodation?
If yes, what kind of support would you like?

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