APPLICATION FOR HOUSING

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APPLICATION FOR HOUSING

Please answer all questions on application for assessment purposes.

**Please sign application and provide all information requested**

**Rental references are required**

Subject *

NAME APPLICANT 1 *

1. ADDRESS *

1. PHONE NUMBER *

1. EMAIL *

1. DATE OF BIRTH *

1. DO YOU HAVE PETS?

1. ARE YOU A PERMANENT RESIDENT OR AUSTRALIAN CITIZEN?

Yes

No

1. ARE YOU OVER 50 YEARS OF AGE

Yes

No

1. PHOTO ID PROOF (eg: Drivers Licence, Passport, etc)

Yes

No

1. CRN CARD NUMBER

1. MY AGED CARE NUMBER

1. ANY MEDICAL CONDITIONS THAT EFFECT HOUSING REQUIREMENTS

1. DO YOU RECEIVE AN AUSTRALIAN PENSION?

Yes

No

1. TYPE OF PENSION

1. TOTAL PER FORTNIGHT

1. **PLEASE ATTACH AN INCOME STATEMENT FROM CENTRELINK/DEPARTMENT OF VETERAN AFFAIRS WITH YOUR APPLICATION FOR EACH APPLICANT**

1. DO YOU HAVE ANY ADDITIONAL INCOME?

Yes

No

1. Income

Bank Interest from Investments

Superannuation Funds

Foreign Pension

ItemOther (Wages etc.)

1. **PLEASE PROVIDE EVIDENCE OF ALL ADDITIONAL INCOME PER ANNUM**

NAME APPLICANT 2

2. ADDRESS

2. PHONE NUMBER

2. EMAIL

2. DATE OF BIRTH

2. DO YOU HAVE PETS?

2. ARE YOU A PERMANENT RESIDENT OR AUSTRALIAN CITIZEN?

Yes

No

2. ARE YOU OVER 50 YEARS OF AGE

Yes

No

2. PHOTO ID PROOF (e.g.: Drivers Licence, Passport, etc)

Yes

No

2. CRN CARD NUMBER

2. MY AGED CARE NUMBER

2. ANY MEDICAL CONDITIONS YOU WOULD LIKE TO REPORT

2. DO YOU RECEIVE AN AUSTRALIAN PENSION?

Yes

No

2. TYPE OF PENSION

2. TOTAL PER FORTNIGHT

2. ***PLEASE ATTACH AN INCOME STATEMENT FROM CENTRELINK/DEPARTMENT OF VETERAN AFFAIRS WITH YOUR APPLICATION FOR EACH APPLICANT***

2. DO YOU HAVE ANY ADDITIONAL INCOME?

Yes

No

2. Income

Bank Interest from Investments

Superannuation Funds

Foreign Pension

Other (Wages etc.)

2. ***PLEASE PROVIDE EVIDENCE OF ALL ADDITIONAL INCOME PER ANNUM***

WHAT IS YOUR CURRENT HOUSING SITUATION (Please tick)?

Private Rental

Caravan Park

Refuge/Hostel

Living with Family/Friends

Community/Public Housing

Own Home

Boarding House

Other

RENT Total Amount Paid Fortnightly

Address

CURRENT RENTAL DETAILS

Have any notices been issued

CURRENT RENTAL DETAILS

Landlord/Agent contact details

CURRENT RENTAL DETAILS

Previous Address 1

PREVIOUS RENTAL DETAILS 1

Reason for Leaving 1

PREVIOUS RENTAL DETAILS 1

Were any notices issued 1

PREVIOUS RENTAL DETAILS 1

Landlord/Agent contact details 1

PREVIOUS RENTAL DETAILS 1

Previous Address 2

PREVIOUS RENTAL DETAILS 2

Reason for Leaving 2

PREVIOUS RENTAL DETAILS 2

Were any notices issued 2

PREVIOUS RENTAL DETAILS 2

Landlord/Agent contact details 2

PREVIOUS RENTAL DETAILS 2

Personal Referee

Contact Number

DO YOU GIVE US PERMISSION TO CONTACT YOUR REFEREE

Yes

No

1. DO YOU HAVE AN ACTIVE APPROVED DEPARTMENT OF SOCIAL HOUSING APPLICATION?

Yes

No

APPLICANT 1

2. DO YOU HAVE AN ACTIVE APPROVED DEPARTMENT OF SOCIAL HOUSING APPLICATION?

Yes

No

APPLICANT 2

NEXT OF KIN DETAILS NAME

RELATIONSHIP TO APPLICANT

PHONE NUMBER

EMAIL

1. DECLARATION To the best of my knowledge the information provided on this form is true and correct.

APPLICANT 1 PRINT NAME

2. DECLARATION To the best of my knowledge the information provided on this form is true and correct.

APPLICANT 2 PRINT NAME

Submit