Change in circumstances form

Change in circumstances formadmin2025-02-26T13:49:05+00:00

Change in circumstances

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of birth

MM slash DD slash YYYY

Jigsaw reference (if known)

Medical

New medical diagnosis

Property has become medically unsuitable due to physical disability

Property has become medically unsuitable due to mental health

Medical unsuitable due to physical disability

Too many stairs

No additional support (rails etc)

New wheelchair user

Medical unsuitable due to mental health

Property on too high a floor level

Issues with neighbours affecting health

Affordability

Rent increase

Additional expenses incurred

Change in income (loss of job/benefits)

Change in household resulting in less benefits

Additional household members

New baby

Returning family member

Additional family members joining family

Number of new people to household

Domestic abuse

Perpetrator has found you

Associates have found you

Environmental Health/Property unsuitability

Category hazard applied by Environmental Health

Boiler broken for a period of time/not being fixed by Landlord/Agent

Other disrepair (for example, ongoing water issues, boiler issues)

Issues with neighbours

Registered office: 3rd Floor, 2 Bristol Avenue, Colindale NW9 4EW