Vincent House

a place where you
can feel at home

contact us
5 Pembridge Square London W2 4EG
Tel: 020 7229 1133
Fax: 020 7243 2646
e-mail:info@vincenthouse.co.uk
Any stay in excess of two weeks requires an application form to be completed and submitted.
Online Application


Application for Accommodation
Family Name*		First Name (s)
Current Address*		Tel No*
Email Address
Permanent Address (if different to above)		Tel No
Nationality		Date of Birth*
Country of birth*
Professional or Business Address*		Tel No*
Next of Kin Name & Address*		Tel No*
Relationship*
Referee Name & Address*		Tel No*
Condition of Residence*	Vincent Housing Association Limited only offers residency in accordance with its Conditions of Residence, a copy of which can be found on the website - please click on Terms & Conditions. Please confirm that you have read the Terms & Conditions and that, if accepted as a resident, you agree to be bound by them by ticking the box
Intended Arrival Date*
Intended Departure Date or Length of Stay*
Please let us know how you first heard of Vincent House
If you were recommended by someone please state their name
Security Code
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Vincent House

5 Pembridge Square London W2 4EG
Tel: 020 7229 1133
Fax: 020 7243 2646
e-mail:info@vincenthouse.co.uk

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