1. HENKILÖTIEDOT                                                                                    

                 1. Hakijan henkilötiedot                                                                                          

Suku- ja etunimet                                      

                                                                                                                                                         

                      Henkilötunnus                                           

                                                                                       

                      Osoite                                                      

                                                                                                                                                         

                      Puhelinnumero                                          

                                                                                       

                      2. Hakijan henkilötiedot                                                                                          

                      Suku- ja etunimet

                                                                                                                                                        

                      Henkilötunnus

                                                                                      

                      Osoite

                                                                                                                                                        

                      Puhelinnumero

                                                                                       

2. HAETTAVAA HUONEISTOA KOSKEVAT TIEDOT                            

                 Kunta, josta asuntoa haetaan                      Kohteen osoite

                                                                                                                                                        

                      Huoneistotyyppi                                         Haluatko hakea muitakin asuntoja kauttamme?

                                                                                                                                   

3. ASUNNON TARVE                                                                                    

                      Asunnottomuus ja sen kesto

                                                                                                                                                        

                      Muuttovelvoite nykyisestä asunnosta ja syy siihen

                                                                                                                                                        

4. NYKYISTÄ ASUNTOA KOSKEVAT TIEDOT                                        

                      Asunnon osoite ja sijaintikunta

                                                                                                                                                        

                      Aikuisten lukumäärä, lasten lukumäärä ja syntymävuodet

                                                                                                                                                        

                      Asunnon varustelutaso ja kunto

                                                                                                                                                        

                      Asunnon huoneluku ja pinta-ala

                                                                                                                                                        

                     

 

 

                    

Omistusasunto

Vuokra-asunto

 

5. TULOT JA VARALLISUUS                                                                       

                      1. Hakijan varallisuus

                                                                                                                                                        

                      2. Hakijan varallisuus

                                                                                                                                                        

Työllisyystilanne              

 

 

 

                     Työsuhde

Vakituinen

Määräaikainen                      asti

Muu, mikä?                                                                    

                     

Työnantajan nimi ja työtehtävät:

                                                                                                                                                  

               

 

 

 

                Työtön:

       Ansiosidonnainen

                           Peruspäiväraha

           Muu, mikä?                                                                                                     

Opiskelija, oppilaitos ja opiskelulinja, opiskeltu                  v., jäljellä                           

                                                                                                                                  

Muu tilanne, mikä?

                                                                                                                                  

Taloudellinen tilanne:

                      Nettokuukausitulot:   n.                               € / kk

6. MUUTON SYY                                                                                           

1.      Avioero/avoero

2.      Työpaikka Kotkasta

3.      Opiskelupaikka Kotkasta

4.      Häätö

5.      Olen myynyt asuntoni

6.      Itsenäistyminen

7.      Minut on irtisanottu, miksi?                                                                             

8.      Muu syy, miksi?                                                                                             

Onko luottotiedoissasi maksuhäiriöitä? EI/KYLLÄ milloin ja mistä tulleita?

                                                                                                                                                        

                                                                                                                                                        

Oletko vuokrannut aiemmin kauttamme asuntoa EI/KYLLÄ, osoitteesta?

                                                                                                                                                        

Muuttaako mukanasi kotieläimiä? EI/KYLLÄ, mitä?                                                                

 

Mistä lähtien ottaisit asunnon vastaan                        /                     200               

Erityistiedot / ehdotukset / vaatimukset / tarjoukset                                            

                                                                                                                                                        

                                                                                                                                                        

 

7. ALLEKIRJOITUKSET                                                                              

 

Paikka ja aika:                                                                                      

 

1. Hakijan allekirjoitus:                                                                                                                                                                                                                             

2. Hakijan allekirjoitus:                                                                                                                                                            

Vakuutan annetut tiedot oikeiksi. Olosuhteiden muuttuessa hakemus korjataan muutoksia vastaavaksi. Tietojen

pyytäminen perustuu valtioneuvoston asetukseen 1191/2001 ja ympäristöministeriön ohjeisiin.

 

8. VAADITTAVAT LIITTEET                                                                      

 

*    Verotodistukset kaikilta huoneistoon muuttavilta yli 18-vuotiailta (ei verokortti) jos kysymyksessä on arava-asunto

*    Selvitys omaisuuden käyvästä arvosta, jos omaisuutta on

*    Muut mahdolliset todistukset, joihin hakija haluaa vedota