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Application form

PLEASE NOTE: This form is for disability accommodation or accommodation at Havelock House.
Required for statistical purposes only
Required for statistical purposes only
For purposes of Disability Housing only. Note that details of your plan may be provided to support providers for matching purposes
Emergency Evacuation Assessment
Why is this important? Havelock Housing need to make sure that we can evacuate people in the event of a fire or other emergency. You must complete this form so that we can ensure that you can safely evacuate the building. Any information you provide will be treated in confidence and stored in line with the Privacy Act 1988 and the Privacy Principles.
I certify that the information in this form is true and correct.
I certify that the information I have submitted on behalf of the applicant is true and correct.