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["TF","NW","ST","CW","S","WV"]
Housing assistance declaration
Authority to act, disclose and receive information
First name:
Last name:
Date of birth
Do you have a fixed address?
Do you have a fixed address?
Yes
Do you have a fixed address?
No
Please provide your last settled address:
Address
Signature
When you are happy with your signature, click Confirm. Once confirmed, you cannot alter your signature.
Leave this field blank
