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Application for a Mutual Exchange

1. Property address:

Tel No: Tenancy Reference Number:

Email Address:

2. Name of present tenant(s) in full:

Surname Other Names Date of Birth Ethnic Origin Disabled Y/N

3. Members of the household. Please give details of all people who will be moving with you:-

Surname Other Names Date of Ethnic Disabled Joint Applicant

Birth Origin Y/N Y/N

4. Are you currently a Stockport Metropolitan Borough Council tenant? YES / NO*

*If NO please give the name and address of your landlord:

................................................................................................................................................................

................................................................................................................................................................

5. Current property details

Type of Property (House, Flat, etc.): ........................................................................................................

Size of Property

a) Number of bedrooms:.....................................................................................................................

b) Number of living rooms:..................................................................................................................

Tenancy start date:.................................................................................................................................

Application Number:

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6. What type / size of property, do you want to move to?

Type of property (tick appropriate):

House � Bungalow �

Flat � Flat with a lift �

Maisonette � Flat with no lift �

Multi-Storey flat � Studio �

Size of property

a) Number of bedrooms:

7. Do you currently have any rent arrears on your account? YES / NO*

* If YES,

a) How much is outstanding: £ ............................................................................................................

b) What arrangement has been made to pay this off?: .........................................................................

....................................................................................................................................................................

....................................................................................................................................................................

Please note: An exchange cannot proceed unless the rent account is clear.

8. Does your current property have any adaptations? YES / NO*

For example, walk in shower, grab rails etc.

* If YES, please give details:

....................................................................................................................................................................

....................................................................................................................................................................

9. Are there any specific property requirements or adaptations you need? YES / NO

For example, central heating, a shower (not a bath), or disabled adaptations.

....................................................................................................................................................................

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10. Proposed exchange

Do you already have someone you would like to exchange with? YES / NO*

* If YES please complete the details below:

Name:

Address:

Telephone No:

Type of property:

Number of bedrooms:

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11. Area preferences

Which areas of Stockport would you like to live in? Please indicate by ticking as many boxes as you like

below - this will not affect the properties you can bid for:

East Area:

Bredbury � Brinnington � Compstall �

Covent Garden � Hazel Grove � High Lane �

Marple � Marple Bridge � Mottram Street �

Offerton � Rectory Fields � Romiley �

Spring Gardens � Victoria Park � Woodley �

West Area:

Adswood � Bramhall � Bridgehall �

Cale Green � Cheadle � Cheadle Heath �

Cheadle Hulme � Councillor Lane � Davenport �

Didsbury Road � Edgeley � Gatley �

Heald Green � Larkhill � Shaw Heath �

Reddish � The Heatons � Lancashire Hill �

12. Alterations to the property

Have you as a Stockport Tenant made any alterations to the property (such as new doors)? If the answer

is YES, before this exchange can be approved you must sign to agree to one of the following:

Please delete whichever is not applicable.

1. Reinstate the alteration to its original state.

2. Allow the Council to charge me for them to carry out the work.

3. The incoming tenant agrees to maintain the alteration without cost to the Council.

13. Do you have any pets? YES / NO*

If YES what sort do you have and how many:

..................................................................................................................................................................

14. Do you give permission for your details to be passed to other suitable exchanges or for

your property details to be included in the Mutual Exchange advert?

� Yes I give permission for the Area Housing Offices to pass on my exchange details.

� Yes I give permission for my property details to be included in the monthly Mutual Exchangeadvert.

Signature (tenant): ..................................................................

Signature (incoming tenant): .................................................

(Please note: A Technical Officer will carry out an inspection before your exchange is agreed)

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DECLARATION

This form has been completed honestly to the best of my / our knowledge. I give permissionfor my Housing Office to carry out checks on the information given to confirm that the detailssupplied are correct.

Name(s) and Signature(s) of occupants:

Name: ......................................................................................................................................................

Signature: .................................................................................................................................................

Name: ......................................................................................................................................................

Signature: .................................................................................................................................................

Date: ........................................................................................................................................................

FOR OFFICIAL USE ONLY

Location Condition

Living room

Dinning room (where applicable)

Kitchen

Bathroom / toilet

Bedroom 1

Bedroom 2

Bedroom 3

Bedroom 4

Bedroom 5

Hall / stairs and landing

Garden - front

Garden - rear

Details of any adaptations

Any other comments: ............................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

Are there any additional reports to attach? YES / NO*

* If YES please state what they are

..................................................................................................................................................................

..................................................................................................................................................................

Date of visit: ...........................................................................................

Name of office visiting: ..........................................................................

Details of Home Visit

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Housing Officer’s comments

Technical Officer’s comments

Manager’s comments

AGREED / REFUSED

Date

Agreement conditions (arethere any specific conditions towhich the exchange has beenagreed - For example, currenttenant to make good a specificalteration to the property).

Name of Officer makingdecision

Signature

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If you want to exchange your home with someone else, pleasecomplete this form. If you would like a copy in large print, Braille, onaudiotape or CD, please contact the Social Inclusion Team on0161 474 2860 or email: inclusion@stockporthomes.org

Stockport Homes is a limited company thatexists to manage the housing stock ownedby Stockport Metropolitan Borough Council.

Ref:764/December2010