Housing Adaptation Grant Formdoc - Kilkenny County Council房适应授予表单文档-基尔肯尼郡议会.docVIP

HGD 1 PLEASE NOTE: NO ESTIMATES ARE REQUIRED AT APPLICATION STAGE Please read the attached conditions prior to completing this form, in particular the checklist at the rear. Incomplete forms will be returned and may lead to delays in your application. All questions must be answered Please write your answers clearly in block capital letters Applicant: __________________________________________________________ (Home Owner) Address: __________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Are you a tenant of Kilkenny County/Borough Council: _____________________________ If yes, how long: ___________________________________________________________ Telephone No: _________________________ Mobile No: __________________ Date of Birth: _________________________ P.P.S. No: ___________________ Occupation: __________________________________________________________ Name of person for whom grant aid is sought (if different from Applicant): _____________________________________________________________________________ Relationship to applicant: ______________________________________________________ Name of the owner of the property to which the proposed adaptation works are to be carried out: _____________________________________________________________________________ Gross Annual Household Income: €______________________________________________ (Please refer to explanatory note 3 below) Is the person with the disability residing at the address above: ________________________ How long has s/he been living at this address: ______________________________________ Please tick appropriate box Yes No Does the proposed development consist of work to a protected structure/listed building and/or its curtilage or proposed protected structure