About BHC Mission & Vision BHC Team Board Members H.U.S.T.L.E. Truck HomeStart Senior & Disabled Loans Tenders & RFP’s Current Tenders & RFP’s Planned Developments Forms & Links Contact BHC BHC Application Form Step 1 of 4 - Demographics 0% Standard Questions for all applicants. Use the word NONE if the question does not apply. Driver’s Licence, passport and other documents (notices to quit, eviction notices, pay stubs and other substantiating documents) need to be uploaded. Tenant can upload pictures taken from their mobile devices. DemographicsName* First Middle Initials Last Previous Names (Maiden, Last known as) Date of Birth* MM slash DD slash YYYY Bermudian* Yes No Current Home Address Email Address Contact Number (Mobile) Contact Number (Work) Total Number of Adults (including the applicant) who will reside in the householdPlease enter a number from 0 to 20.Total Number of Children who will reside in the householdPlease enter a number from 0 to 20.Primary Applicant Name, Date of Birth, Gender, Relationship, EmploymentFor each household member enter their name, age, gender, how they are related, whether they are employed or in school.Spouse/Partner Name, Date of Birth, Gender, Relationship, EmploymentFor each household member enter their name, date of birth, gender, how they are related, whether they are employed or in school.Child 1 Name, Date of Birth, Gender, Relationship, SchoolFor each household member enter their name, date of birth, gender, how they are related, whether they are employed or in school.Child 2 Name, Date of Birth, Gender, Relationship, SchoolFor each household member enter their name, date of birth, gender, how they are related, whether they are employed or in school.Child 3 Name, Date of Birth, Gender, Relationship, SchoolFor each household member enter their name, date of birth, gender, how they are related, whether they are employed or in school.Child 4 Name, Date of Birth, Gender, Relationship, SchoolFor each household member enter their name, date of birth, gender, how they are related, whether they are employed or in school.Other Applicant Name, Date of Birth, Gender, Relationship, EmploymentFor each household member enter their name, date of birth, gender, how they are related, whether they are employed or in school.Emergency Contact Name Emergency Contact PhoneEmergency Contact Relationship Are you currently renting? Yes No How much is your current rent? Have you ever rented from BHC? Yes No If yes, what was your reason for leaving?AffordabilityArrearsEvictionLocationFamily issuesIf you have arrears or bad debt with BHC, have you attempted to pay on it? Yes No I don't have arrears or bad debt with BHC Driver's Licence or Passport* Drop files here or Select files Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 16 MB. Tenant can upload pictures taken from their mobile devices.Other Documents Drop files here or Select files Max. file size: 16 MB. E.g. notices to quit, eviction notices, pay stubs and other substantiating documents. EmploymentAre you employed?* Yes No Type of employment Part time Full time Temporary Permanent Have you applied to the Department of Workforce Development Yes No Current employer Position at Company Employer's address and contact info (email, phone number)Describe or explain your current employment information, i.e. length of time, conditions, security of employment, etc.Pay StubAccepted file types: jpg, gif, png, pdf, Max. file size: 16 MB.FinancingHow will you pay rent? Income/Salary Financial Assistance Pension Disability Do you have funds set aside for a security deposit? Yes No If you require Financial Assistance have you already applied? Yes No How much does Financial Assistance pay towards your rent? What is your household's WEEKLY salary? This is the total for everyone over 18 years of age.What is your household's MONTHLY salary? This is the total for everyone over 18 years of age.Do you or any household member own a home or have any property assets? Yes No What type of transportation do you own? HousingType of Housing Required Room rental Studio Apartment 1-bedroom 2-bedroom 3-bedroom Reasons for housing A: Homeless B: Housing needed within a week C: Domestic issues D: Referral by agency E: Possession granted - court order F: Disaster G: Household with small children H: Written or verbal notice I: Health & safety J: Space too small K: Disability L: Current tenant M: Cost - cannot afford rent N: Space too large O: Quality - looking for better neighborhood P: Quality - current abode needs repair Q: Other R: Evicted from family home / a family member's home Check all that applyOther reason for housing How long have you lived in your current housing? Describe in your own words the overall reason you require housing What Date are you required to leave your current housing? MM slash DD slash YYYY Do you have a Notice to Vacate? Yes No Have you been to court? Yes No What is the name and contact information for your landlord? Is the communication with your landlord in good standing? Yes No Do you have arrears? Yes No If yes, how much? Have you ever been evicted? Yes No If yes, why? Does any household member have any special housing needs? i.e. mobility requirements? Are there other agencies involved with your family? A: DCFS, Adolescent, Family Services B: Department of FA C: MAWI D: KEMH E: Court Services F: Department of Corrections G: Centre Against Abuse H: Other What other resources have you used to find housing? Real estate agencies Local media sources Emoo Newspapers Word of mouth Do you have a parish or location preferences? Do you have a bank account? Yes No Do you have debt with collection agencies? Yes No How much is your total debt? Are you able to have utilities, such as BELCO connected in your name? Yes No Do you have appliances and furniture? Yes No How would you describe your housekeeping practices? Poor Good Excellent Has a landlord ever complained about your housekeeping practices? Yes No Has you ever been evicted because of this complaint? Yes No Provide any other information or questions that can help with your application process. In accordance with Bermuda Housing Corporation policy I hereby give my consent and authorization to the Corporation to make such enquiries as it deems necessary to verify information pertaining to my criminal, financial, social and medical records (includes psychiatric, and substance abuse records). In addition, I authorize any person, corporation or social agency having knowledge of such information to confirm the same on the request of the Bermuda Housing Corporation. Lastly, my consent indicates I have read this form and/or have had it read to me. I know what information is to be disclosed and am aware of all consequences related to disclosure of the material.Consent* I agree.Date* MM slash DD slash YYYY Name First Last NameThis field is for validation purposes and should be left unchanged.
