You must have JavaScript enabled to use this form. Current Information about you Household members Property information Past 5 year address history Partners past 5 years address history Household needs and finances Complete Hampshire Homechoice registration number (if known) First name Surname Date of birth Current address Postal address if currently no fixed abode Last settled address (if different from above) Contact number Email address National insurance number Translator required - None -YesNo Please indicate language What is the reason for homelessness? - None -Received a s21 noticeDomestic abuseAsked to leave by family of friendsOther (please specify) Please give us more details Have you got any accommodation available that is safe to occupy today? - None -YesNo Have you received written notice? - None -YesNo If you have not received valid notice it is likely we will not be able to proceed with a homelessness application please provide a copy via support.team@easthants.gov.uk or upload this via your Hampshire Home Choice account. Please give date of notice expiry Do you feel unsafe remaining in your accommodation but are safe today? - None -YesNo Please give details if you have said yes Are you currently rough sleeping - None -YesNo Have you approached another council in the past 6 months? - None -YesNo If yes, which council did you approach and what was the outcome?
