Application for Accommodation

If you wish to apply for accommodation, please complete the online form below.

Note: All fields below are mandatory and must be completed.  If a field, e.g. "Name of Spouse / Partner / Joint Applicant" does not apply to you, please state "Not applicable".

Applicant's information
Employer's information
Joint Applicant's information
Next of Kin
Residency
Family information: provide details of all who will be living with you

NOTE: No animals allowed in Urban Plus accommodation

Current accommodation information
References: Please supply two written character references from persons other than relatives

Note all information provided in this section is confidential

Earnings
Assets

Note: It is Urban Plus' policy to run a credit check on prospective tenants, and making this application constitututes an authority to do so.

Please provide a doctor's medical certificate or information from your support worker (if you have one). Failure to do so, may put your application with Urban Plus at risk.

All information provided in this section is confidential

If no, please advise Yes or No to the following statement

I/we declare that the information contained in this application is true and correct to the best of my/our knowledge and acknowledge the right of Urban Plus Ltd ("Urban Plus") to check the validity of the information supplied including medical information from my doctor or key worker if applicable. If misleading or false information is provided, this application may be cancelled.

Privacy Statement

I/we acknowledge that:

1. Personal information concerning me provided to Urban Plus, whether contained in the request or otherwise obtained is provided and may be held, used and disclosed by Urban Plus:

    • to process and determine my application
    • to enable Urban Plus to communicate with me for any purpose
    • to enable Urban Plus to provide me, or have provided to me, advice and information concerning products and services that Urban Plus believes may be of interest to me
    • to enable Urban Plus to administer and maintain its records and carry out its required function.

2. The personal information provided in this request is collected by and will be held by Urban Plus Limited, whose address is: Private Bag 31-912, Level 1, Corner Queens Drive and Laings Road, Lower Hutt

3. I have the right under the Privacy Act 1993 to obtain access to and to request correction of any information held by Urban Plus Limited concerning me.