Scheme of Assistance Application

Your Details (the applicant)
1. Label
  1. Title*
  2. Please Specify
  3. First Name*
  4. Surname*
  5. Telephone (mobile)
  6. Telephone (home)
  7. Email*
2. Your address
  1. Your Address
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  4. Your Address
    
    OSG Postcode Search (Custom drop-down list)
    
    Postcode
    
    Address
Who owns the house where the adaptation is being carried out?
1. Do you own the house?*
  
  Yes
  
  No
2. Are you the sole owner?
  
  Yes
  
  No
3. Owner's Details
  1. Title
  2. Please Specify
  3. First Name
  4. Surname
  5. Telephone (mobile)
  6. Telephone (home)
  7. Email
  8. Is there a second owner?
    
    Yes
    
    No
4. Second Owner's Details
  1. Title
  2. Please Specify
  3. First Name
  4. Surname
  5. Telephone (mobile)
  6. Telephone (home)
  7. Email
5. Joint Owner's Details
  1. Title
  2. Please Specify
  3. First Name
  4. Surname
  5. Telephone (mobile)
  6. Telephone (home)
  7. Email
6. Evidence
  1. Please note that unless you are the sole owner of property you will need to provide evidence that you have consent to have these adaptations carried out. You should have been sent a Homeowners Consent form along with your Scheme of Assistance letter from us. You will also find a copy on our Scheme of Assistance Application Information webpage.
    
    Please complete this form and upload this using the below 'Choose file' button. All owners must sign this and we will accept either a scanned copy or photo from your phone.
    
    Alternatively, you can complete this form and return it to; Scheme of Assistance, Housing, Customer and Building Services, West Lothian Civic Centre, Howden South Road, Livingston, West Lothian, EH54 6FF.
  2. Evidence
  3. File type that can be uploaded are : .DOC, .DOCX, .BMP, .PNG, .JPG, .TIF, .GIF, .XLS, .XLSX, .PDF and .TXT
Dealing with your application
1. Would you like someone else to deal with the application on your behalf?*
  
  Yes
  
  No
2. Nominated person's details
  1. Title
  2. Please Specify
  3. First Name
  4. Surname
  5. Telephone (mobile)
  6. Telephone (home)
  7. Email

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Scheme of Assistance Application

Your Address