Bracknell

Tuesday, 07-Feb-2012

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>New Household Registration

New Household Registration

This is the first part of the application process. After you click on the submit button, you will see your login details and you can then complete your rest of your application.

New household registration

Details

Applicant Details

Title:*

First name:*

Family name:*

Have you been known by any other names?

Date of birth:* (dd/mm/yyyy)

National Insurance Number:*

Gender:*

Marital status - are you:*

Do you have a disability:

Disability details:

The following three questions are for monitoring purposed only and will not affect your application.

Ethnic origin:

If other, please specify:

Religion:

If other, please specify:

Sexual orientation:

If other, please specify:

Current Address Details

Address 1:*

Address 2:*

Address 3:

Address 4:

Postcode:*

Date moved in to this address:* (dd/mm/yyyy)

Work telephone:

Home telephone:*

Mobile telephone:

Email:

Other details

Are you pregnant? yes no

If yes, when is the baby due? (dd/mm/yyyy)

Do you or any of your household have a pet? yes no

If yes, please specify:

Do you or any of your household have a live in carer? yes no

Correspondence address

Same address as main applicant: yes no

If yes, then please ignore the following address fields

Address line 1:*

Address line 2:

Address line 3:

Address line 4:

Address line 5:

Postcode:*