Vincent House - Application for Accommodation

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
Please enter above security code*
Website Privacy Statement Vincent Housing Association Limited believes strongly in protecting the personal information supplied by applicants, residents and visitors and we will never voluntarily pass your details to another party. Your personal information is retained in a secure data system and is regulated by the Data Protection Act. Any personal information you choose to supply will be used only for the purposes of administering your account and allied purposes, should your application be accepted. We are against spam. However, we would like to keep you informed of news and events through occasional e-mails. Please click on to the box if you do not wish to receive information from us. If you agree to receive information from us, you can change your mind at any time. Please contact info@vincenthouse.co.uk or leave a signed note addressed to the Secretary at reception.

Vincent House

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