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APPLICATION FOR ACCOMMODATION WITH MERSEA ISLAND TRUST

Complete our online form below or print the Postal form which you can download here.

PLEASE RETURN THIS FORM TO:
Mersea Island Trust
Akhurst Court
Melrose Road
West Mersea CO5 8JB
Telephone: 01206 383706

Please review our Data Privacy Notice for applicants here.

Your name *

First

Last

Your date of birth *

Your address *

Your phone number *

Your mobile phone number

Your email address *

Do you have any disabilities?

Does anyone else live with you? *

What is their relationship to you?

Will they be moving with you?

If yes, please complete details. Second applicant name

First

Last

Second applicant date of birth

Second applicant phone number

Second applicant mobile number

Second applicant email address

Do they have any disabilities?

Does anyone applying for accommodation have a car or mobility scooter? *

Does anyone applying for accommodation have a pet? *

Does anyone applying for accommodation smoke? *

If you are a non resident on Mersea Island, what is your local connection?

What is the reason in applying for accommodation?

Which GP surgery are you registered at? Doctor's name *

Surgery address *

Doctor's phone number *

Who is listed as your next of kin? Name *

Next of kin phone number

Next of kin address

Next of kin email

Tick to Sign Electronically *

Tick box to confirm this form is electronically signed by all applicants named above

Mersea Island Trust

Address:Akhurst Court, Melrose Road, West Mersea, Essex CO5 8JB
Phone:01206 383706Opens in your application
Email:Email usOpens in your application

Who we are...

Mersea Island Trust

Mersea Island Trust was formed in 1961, to provide warden supported accommodation for the elderly of Mersea Island to rent.

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