36. Reticulation, either automatic or manual, is to be regularly ch ecked to ensure in working order. Any damage created by tenant will be tenant’s responsibility to rectify. 37. Where the property has allocated parking bay/s, the tenant agrees to only park in the bay/s allocated to the property at all times. 38.
February 2021 Version NRAS Application Form 121 Wharf Street CANNINGTON WA 6107 I Ph 08 9390 1442 Information Required Checklist Dear Applicant, Thank you for your interest in R&H's NRAS property. To ensure that applicants meet the income requirements to be eligible for a NRAS property, documented proof is required. The Tenant Income Questionnaire will outline income that is to be declared. Pleasebeadvised that your application willnot beprocessed unless all required formshavebeencorrectly filledout/signed,supportingdocumentation provided. Pleaserefer tothecheck list below toensure youhaveprovidedall required information 1. Cover Letter: Introducing yourself willallow the landlord to choose the NRAS - qualified applicants that best suits their preference. 2. Tenancy Application Form. 3. 100 Points of I.D per applicant- Include a minimum of 1 form of photo I.D - 60 points each: Driver license, Passport, Photo I.D. - 30 points each: Medicare card, Credit/ATM card, Pension card. - 10 points each: Utility bills, ban statements, Car registration papers 4. NRAS Tenant Consent Form - oneper applicant 5. Demographic Form -one perhousehold 6. Tenant Income Assessment Information per applicant (even if zero Income) 7. Zero Income Statutory Declaration one for each tenant who earned no income in the past 12 months. 8. Supporting documentation - for each income earning applicant: - PAYG Summary from last Financial Year and three most recent payslips for each employment - Centrelink INCOME STATEMENT (no other statements areaccepted) and - 12-month payment history from Centrelink (list of payments) - Child support statement Raine & Horne NRAS 121 Wharf Street Cannington WA 6107 Ph: (08) 9390 1442 www.raineandhorne.com.au/nras APPLICATION TO LEASE RESIDENTIAL PROPERTY The owner of the premises is attempting to locate the most suitable tenant, a tenant who pays rent on time and takes care of the premises. To enable the owner of the premises to determine in their opinion, who is the most suitable applicant, the managing agent requires some background information regarding previous premises that you have leased, and information on how you will pay the rent. The following application and information is not the lease. Its purpose is to make you aware of conditions associated with making an application as well as special conditions that will be associated with the prospective lease. Application must be handed in to the office & completed FULLY prior to processing If your application is successful and you exercise your option to sign the lease, please note the following: When signing the lease we require all amounts payable to be paid in to our account by direct deposit. Cash rental payments are not accepted at this office. Your unique reference code will be issued once your application has been selected. These details will be matched to your account and must be used at all times. All tenants must sign the lease and pay the total ingoings before the keys are handed over. It is the TENANTS responsibility to ensure the electricity, gas and telephone are connected. It is the TENANTS responsibility to find out if there is an existing telephone connection to the property. You will be responsible for the telephone connection, and/or line connections if applicable as the outgoing tenant may or may not have had them disconnected. ALL APPLICATIONS RECEIVED ARE SUBJECT TO LANDLORD'S APPROVAL (The owner or agent is not obliged to explain in the event that your application is not accepted) Annexure A - SPECIAL CONDITIONS TO LEASE In addition to the standard conditions as set out in "The lease Agreement", all leases will be subject to the following "Special Conditions". 1. Any change to the occupancy of the property must be reported to the Property Manager. New occupants must go through the application and income reporting process before moving in. Approval may be subject to compliance requirements and landlord consent. Failure to follow this clause will result in termination of tenancy. 2. The tenant acknowledges and confirms they have viewed the said property, and accept it in its current condition. 3. Rent may be subject to review and increase every 6 months to reflect market value. 4. The Tenants shall not use the premises to cause or permit the premises to be used for any illegal purpose, or permit or cause a nuisance. The tenant shall use the premises safely for a dwelling and shall not cause or permit the premises to be used for any other purpose without the prior consent from the owner/agent. 5. The tenant agrees that they will notify Raine & Horne NRAS of any changes to their personal or work contact phone numbers and email addresses. 6. Tenant may not transfer their interest under this Tenancy Agreement, or sub-let the premises. 7. The applicants agree to pay rent one period in advance, except for the first two weeks rent. 8. Failure to pay your rent by the due date may result in termination of your lease agreement and your name being recorded on the National Tenancy Database. 9. Tenants are to use their specially assigned code when making payments. Failure to use your assigned banking code may incur a Breach Notice. 10. The tenant agrees that upon receipt of the Property Condition Report, they will thoroughly check and amend (if applicable) and return within 7 days. Failure to return the report within specified time will result in the final inspection being cross-referenced with the original Property Condition Report. 11. The tenant acknowledges and is aware that the agent, using the office key where applicable, will carry out regular inspections (in most cases, 3 monthly) on the property. First inspection will be conducted approximately 6 weeks from start of lease. The tenant further acknowledges that a reinspection fee of $50 may apply if the inspection cannot be performed for any reason attributable to the tenant, or if the inspection is found to be unacceptable and requires a follow up inspection. 12. The tenant permits the taking of digital photos at routine inspections for the express purpose of communicating the inspection and any comments to the landlords. 13. Telephone and electricity services must be transferred into your name upon occupancy and disconnected upon vacating. If the utilities are sub-metered the tenants acknowledge and agree that the electricity and gas accounts are supplied to the Property Manager (Raine & Horne NRAS) and that these accounts will be invoiced direct to the tenant by Raine & Horne NRAS with payment to be made within fourteen (14) days. 14. The owner of the property is under no obligation to provide direct telephone or internet connection services to the property in question. 15. The tenant acknowledges that any accounts levied by Raine & Horne NRAS (e.g. water consumption) are payable within fourteen (14) days. Accounts outstanding for more than 7 days may attract late fee. 16. Tenants will be liable for any bank fees associated with dishonoured cheques. 17. During the term of your tenancy the tenant will be responsible for replacing tap washers. If taps continue to leak after washers have been changed, please notify Raine & Horne. We suggest that you regularly check your water meter in order to be aware of the amount of water being consumed. If you are experiencing difficulties or problems please contact your Property Manager. 18. The tenant must ensure they keep the kitchen/cooking area clean and free from grease build-up on walls, tiles, benches, flooring and the range hood (inside & out). This will ensure prevention of discolouration to all said surfaces. The agent will not tolerate oil build-up; the tenants must clean regularly to prevent build-up and staining. 19. All exhaust fans in the premises must be kept clean, grease and dust free, for fire prevention reasons and to prevent motor damage. If damage occurs through failure to maintain in cleanly manner, tenants are liable to replace the motor at their cost. 20. Tenants agree not to use bleach on plastic toilet seat/lids and cisterns, as this burns the plastic over time. 21. No smoking is permitted inside the property. The tenant will be responsible for any damage caused by smoking inside (such as stench to carpets/wall paint and window treatment, staining of the aforementioned). 22. The tenant agrees to use protective felt pads on the base of furnishings placed on timber flooring to avoid scratching and damage. 23. Office chairs with wheels must have protective mat underneath to prevent damage to carpet/flooring. 24. No stiletto heels are to be worn on floorboards/vinyl flooring, stiletto damage is not considered fair wear and tear, and any damage will be rectified at the tenant's expense. 25. Tenants are responsible for replacing batteries in smoke detectors, doorbell, security alarm control pad, reticulation panel, garage remotes etc, if applicable to the property. 26. Smoke detectors and/or security systems are not to be removed, relocated with or tampered with. All faults are to be reported to the Property Manager within 24hrs. 27. Raine & Horne hereby notifies the tenants that it is the tenant's responsibility to ensure they have their own contents insurance during the tenancy. The owners building insurance does not protest the tenants contents. 28. The Tenant acknowledges that the owner WILL NOT contribute to the cost of lighting gas hot water systems, stoves, ovens or heaters unless proven to be defective. Proof of defective apparatus to be provided by Tenant. 29. No pot plants are to be kept directly on the floors at any time. Any floor damage will be repaired/replaced at the tenant's expense. 30. The tenant acknowledges that unless advised otherwise in writing by Raine & Horne, no open fireplaces are to be used at any time. 31. . NOTE: OWNER'S INSURANCE DOES NOT COVER TENANT'S CONTENTS. 32. Tenant is responsible for a locksmith if s/he has lost the keys or if s/he has locked themselves out of the property after hours at their own expense, or an upfront fee of $50.00 is payable for a Staff member to open the office and supply you with our office set of keys. They must be returned by 9.00am the next business day. If during business hours you may contact your Property Manager to borrow the office keys, you must provide ID when collecting the keys & keys must be returned the same day. 33. Tenants agree that no posters, nails, stickers, poster putty, blu-tac, tape or fittings are to be placed on walls, doors, door frames, windows, cupboards or any other surface within the premises other than items listed on the property condition report or agreed by the owner/agent. 34. Where the property has a private swimming pool, the tenant acknowledges and agrees to keep clean and in good serviceable and working order the pool and all its ancillary equipment and apparatus. In the event the landlord or his agent is dissatisfied with the standard maintained by the tenant then the tenant agrees to the agent engaging an outside swimming pool contractor to attend to the premises the cost of which will be borne by the tenant and added to the regular rent sum. 35. Unless otherwise stated in your agreement the outside grounds are the responsibility of the tenant, this includes lawns and gardens. The tenant must ensure they keep all plants healthy, trimmed and controlled regularly during tenancy to prevent overgrowth. It is the tenant's responsibility to maintain creepers/shrubs to the level in which they see to an acceptable level. 36. Reticulation, either automatic or manual, is to be regularly checked to ensure in working order. Any damage created by tenant will be tenant's responsibility to rectify. 37. Where the property has allocated parking bay/s, the tenant agrees to only park in the bay/s allocated to the property at all times. 38. The tenant agrees to use drip trays on the driveways/carport areas to prevent oil damage. Drip trays to be purchased at the tenant's expense. STRICTLY NO PARKING ON LAWNS OR VERGES. 39. Any damages caused by the tenant are to be reported to the property manager within 24hrs of them occurring. Damages are to be rectified immediately, unless the owner agrees to wait until tenant vacates. All repairs are to be conducted by a professional trades person 40. The tenant/s agrees to notify the agent of their intention to extend the lease at least forty five (45) days prior to the expiry of this lease, the agent shall contact the owner for confirmation of the desired lease extension only upon the tenant's verbal or written enquiry. 41. The Tenant agrees to give thirty (30) days notice in writing when they wish to vacate, either on or after the expiry of the lease with such notice to commence from the date the notice is received in our office. The Tenants also acknowledge and agree to the agent advertising the availability of the premises during the notice period and allowing inspections for prospective tenants during normal business hours. Twenty four (24) hours verbal notice given to the current tenant of such inspection. 42. The tenant acknowledges and agrees that should they wish to vacate the premises before the end of the tenancy; the following fees and charges will apply, in addition to the standard moving out costs. * Rent and all other outgoings on the property until a new tenancy has begun. * Reimbursement to the owner for the cost of the inspection/inventory fee. * All advertising costs * Reimbursement of the unexpired portion of the original Letting Fee * Upkeep of the property until relet 43. Upon vacation of the premises the carpets must be professionally steam cleaned, NOT dry-cleaned. Receipt must be provided to the agent before release of the tenant's security bond. 44. Tenant is responsible for the flea treatment of carpets upon vacating if s/he has a pet residing at the property. Receipt must be provided to the agent before release of the tenant's security bond. 45. The bond will not be refunded until the final bond inspection has been conducted, keys are returned to the Raine & Horne NRAS office, all items are in the same condition as stated on the property condition report, and any outstanding amounts are paid in full (e.g. water consumption) 46. Any rubbish left in or around the property upon vacation shall be removed at the tenant's expense. 47. The tenant acknowledges that if cleaners are required to attend the property after vacating to bring the property to the standard as per the property condition report the tenant will be charged the cleaning fee incurred. 48. At end of lease all keys are to be returned to Raine & Horne NRAS, including any extra keys that have been cut during tenancy, before 5pm close of business. Any missing keys/remotes will be at the tenant's expense to replace. 49. At end of lease all keys are to be returned to Raine & Horne NRAS, including any extra keys that have been cut during tenancy, before 5pm close of business. Any missing keys/remotes will be at the tenant's expense to replace. 50. The tenant agrees & acknowledges ALL NOTICES will be sent electronically. All notices will be on your tenant portal & sent to your email. The tenant agrees to regularly check their email & SMS notifications from Raine & Horne NRAS. 51. The tenant is aware that all grout is to be professionally cleaned at the end of the tenancy. TENANCY APPLICATION FORM Regular Rental PREMISES DETAILS Address: Lease commencement date: Lease term: Rent per week OCCUPANTS Number of adults: Number of Dependants: Full name's and age of persons to reside on the premises: 1. 2. 3. 4. 5 6 PETS Type/Breed: Number: USE OF PREMISES Will the Premises be used for business purposes? Yes/ No (please circle) Type of business use: Are any occupants smokers: Yes / No NRAS Rental PRIVACY STATEMENT We are an independently owned and operated business. We are bound by the National Privacy Principals. We collect personal information about you in this form to assess your application for a residential tenancy. We may need to collect information about you from your previous landlords or letting agents, your current or previous employer and your referees. Your consent to us collecting this information is set out below. We may disclose personal information about you to the owner of the property to which this application relates. If this application is successful we may disclose your details to service providers relevant to properties at your request. You have the right to access personal information that we hold about you by contacting our privacy officer. If you do not complete this form or do not sign the consent below then your application for a residential tenancy may not be considered by the owner of the relevant property, or if considered, may be rejected CONSENT I, the applicant, acknowledge that I have read the Privacy Disclosure Statement. I authorise the agent to collect information about me from: 1. My previous letting agents/landlords, 2. My personal referees, 3. Any tenancy Default Database which may contain personal information about me. I also authorise the agent to disclose the personal information collected about me to the owner of the property even if the owner is a resident outside Australia and to any third parties valuers, contractors, sales people, insurance companies, bodies corporate, other agents and default databases. Applicant 1: Signature Date Applicant 2: Signature Date Applicant 3: Signature Date APPLICANT 1 DETAILS Name: Email: Phone (H): Phone (W): Mob: Date of birth: / / Driver's License/18+ card No.: Passport No.: Driver's License/18+ card State: Passport Country: Health Care Card No.: Pension Card No.: Health Care Card Expiry: Pension Card Expiry: APPLICANT'S HISTORY Current Address: Period of Occupancy: Situation: Other situation: Renting/owning/other Landlord/Agent Details Name: Phone: Rent: Payment Period: Reason for leaving: weekly/fortnightly/monthly Previous Address: Period of Occupancy: Situation: Renting/owning/other Other situation: Landlord/Agent Details Name: Phone: Rent: Payment Period: Reason for leaving: weekly/fortnightly/monthly Have you ever been evicted from a premises? Yes/No (please circle) Are you currently in debt to any landlord or agent? Yes/No (please circle) EMPLOYMENT (NOTE: If occupation is self employments please provide a statement of income from your accountant or tax returns) Current occupation: Employment Type: Duration: Weekly Income: Employer/Business Name & ACN/Centrelink Details: Address: Contact: Phone: Previous Occupation: Employment Type: Duration: Weekly Income: Employer/Business Name & ACN/Centrelink Details: Address: Contact: Phone: Student at: Course Name: Duration: REFEREES (All Referees should not be related to you) Referee 1: Phone: Relationship: Referee 2: Phone: Relationship: Referee 3: Phone: Relationship: Referee 4: Phone: Relationship: EMERGENCY CONTACT NOTE: This information is required in case we need to contact you as a matter of urgency arising from your tenancy and your normal contact details are not responding. Next of kin: Phone (H): Address: Phone (W): Mobile: Other: Phone (H): Address: Phone (W): Mobile: APPLICANT 2 DETAILS Name: Email: Phone (H): Phone (W): Mob: Date of birth: / / Driver's License/18+ card No.: Passport No.: Driver's License/18+ card State: Passport Country: Health Care Card No.: Pension Card No.: Health Care Card Expiry: Pension Card Expiry: APPLICANT'S HISTORY Current Address: Period of Occupancy: Situation: Other situation: Renting/owning/other Landlord/Agent Details Name: Phone: Rent: Payment Period: Reason for leaving: weekly/fortnightly/monthly Previous Address: Period of Occupancy: Situation: Renting/owning/other Other situation: Landlord/Agent Details Name: Phone: Rent: Payment Period: Reason for leaving: weekly/fortnightly/monthly Have you ever been evicted from a premises? Yes/No (please circle) Are you currently in debt to any landlord or agent? Yes/No (please circle) EMPLOYMENT (NOTE: If occupation is self employments please provide a statement of income from your accountant or tax returns) Current occupation: Employment Type: Duration: Weekly Income: Employer/Business Name & ACN/Centrelink Details: Address: Contact: Phone: Previous Occupation: Employment Type: Duration: Weekly Income: Employer/Business Name & ACN/Centrelink Details: Address: Contact: Phone: Student at: Course Name: Duration: REFEREES (All Referees should not be related to you) Referee 1: Phone: Relationship: Referee 2: Phone: Relationship: Referee 3: Phone: Relationship: Referee 4: Phone: Relationship: EMERGENCY CONTACT NOTE: This information is required in case we need to contact you as a matter of urgency arising from your tenancy and your normal contact details are not responding. Next of kin: Phone (H): Address: Phone (W): Mobile: Other: Phone (H): Address: Phone (W): Mobile: APPLICANT 3 DETAILS Name: Email: Phone (H): Phone (W): Mob: Date of birth: / / Driver's License/18+ card No.: Passport No.: Driver's License/18+ card State: Passport Country: Health Care Card No.: Pension Card No.: Health Care Card Expiry: Pension Card Expiry: APPLICANT'S HISTORY Current Address: Period of Occupancy: Situation: Other situation: Renting/owning/other Landlord/Agent Details Name: Phone: Rent: Payment Period: Reason for leaving: weekly/fortnightly/monthly Previous Address: Period of Occupancy: Situation: Renting/owning/other Other situation: Landlord/Agent Details Name: Phone: Rent: Payment Period: Reason for leaving: weekly/fortnightly/monthly Have you ever been evicted from a premises? Yes/No (please circle) Are you currently in debt to any landlord or agent? Yes/No (please circle) EMPLOYMENT (NOTE: If occupation is self employments please provide a statement of income from your accountant or tax returns) Current occupation: Employment Type: Duration: Weekly Income: Employer/Business Name & ACN/Centrelink Details: Address: Contact: Phone: Previous Occupation: Employment Type: Duration: Weekly Income: Employer/Business Name & ACN/Centrelink Details: Address: Contact: Phone: Student at: Course Name: Duration: REFEREES (All Referees should not be related to you) Referee 1: Phone: Relationship: Referee 2: Phone: Relationship: Referee 3: Phone: Relationship: Referee 4: Phone: Relationship: EMERGENCY CONTACT NOTE: This information is required in case we need to contact you as a matter of urgency arising from your tenancy and your normal contact details are not responding. Next of kin: Phone (H): Address: Phone (W): Mobile: Other: Phone (H): Address: Phone (W): Mobile: Motor Vehicles No more than ............. vehicles will be parked on the premises at all times Make Colour Rego N° Make Colour Rego N° Make Colour Rego N° Make Colour Rego N° Ministry of Housing Bond Do you intend applying for bond assistance Yes / No Please note: If you answered YES to the above question, you will not be permitted to move into the property until such time as: a) This office has received written confirmation from the Ministry of Housing guaranteeing and outlining the amount of bond payable. b) Amounts from the Ministry of Housing have been paid & cleared into our account. DECLARATION I, the Applicant/s, hereby offer to rent the property from the owner under a lease to be prepared by the Agent. Should this application be approved, I acknowledge that I will be required to pay the following amounts: $________ rent per week, or $ __________ rent per calendar month First payment of rent in advance: $______________ Rental Bond $______________ Subtotal $______________ Amount payable upon signing Tenancy Agreement: $______________ Total I acknowledge that this application is subject to the approval of the owner. I declare that all information contained in this application is true and correct and given of my own free will. I declare that I have inspected the premises and am satisfied with the current condition and cleanliness of the property. Applicant 1: Signature Date Applicant 2: Signature Date Applicant 3: Signature Date February 2021 The National Rental Affordability Scheme Tenant Demographic Assessment and Consent Form When to use this form This is an approved form under section 44 of the National Rental Affordability Scheme Regulations 2020. This form needs to be completed by you as the tenant and the approved participant/property/tenancy manager so the Department of Social Services (the department) can verify tenant eligibility for the National Rental Affordability Scheme (NRAS). The approved participant must provide a tenant consent form for each tenant of the dwelling. This form requests information about you and the approved rental dwelling which, includes: the length of the lease; the number and ages of occupants residing in, or will reside in, the dwelling; sources and details of income earned (noting the approved participant will need to provide supporting evidence either at the time of completing the form or at a later date); the amount of rent that will be charged. Tenant's consent to give information For the purposes of NRAS, by completing and signing Part B of this form you agree to the collection, use and disclosure of your personal information contained in this form. You also agree to the collection, use and disclosure of any additional or supporting information collected by the property manager/approved participant throughout the period of your tenancy. In addition to signing this form, any additional or supporting information you provide to the property manager/approved participant may be forwarded to the department to support the information provided in the tenant consent form. If you do not agree, this may affect your eligibility for NRAS. You can ask your approved participant/property manager to give you a copy of the information that they have provided to the department. When is the form required? Before the tenancy starts (at point of entry) Approved participants/property/tenancy managers are required to provide both Part A and Part B of this form to prospective tenants. Each prospective tenant must complete and sign Part B of this form prior to entering into any lease or rental agreement for an NRAS approved rental dwelling. During the tenancy period Part A and Part B of this form is required to be submitted by the anniversary of the initial start of the tenancy each year. 1 Part A Dwelling and Lease Details (approved participant to complete) Approved participants are required to notify the department any time there is a change to the lease or to the amount of rent charged. The department requires approved participants to provide the department with evidence of the change in rent (such as a rent variation letter or an updated signed lease. A supporting Tenant Demographic Assessment must be entered in the NRAS portal to capture any change). Approved participants are required to provide the department with an updated Part A of this form, when there has been a change to the amount of rent charged or a new lease has been signed. Part B Tenant Consent Form (Tenant to complete) Tenants are required to provide a consent form at the commencement of a new lease and then by the anniversary of the initial start of the tenancy each year to confirm the household income limits and to provide a review of income. If a new tenant joins the household a new tenant consent form must be completed. Please note the date the new tenant joins the household does not restart the tenancy year for the household, the anniversary will continue to be the anniversary of when the original tenants became eligible tenants and a new Part B is to be completed on this date. All adult tenants and independent minors (persons aged under 18 years and residing in the household but living independently, i.e. not financially dependent on an eligible tenant over the age of 18 years) are required to sign the Tenant Consent Form signature page. Please ensure each tenant signs and completes the signature page (page 10). It is your responsibility as a tenant to notify your approved participant/property/tenancy manager any time there is a change to the household income or household demographics (such as a new person (adult or child) joins the household). Tenants may provide the approved participant/property/tenancy manager with an updated Part B of this form at this time, however, will still be required to submit a signed tenant consent form before the next anniversary of the tenancy date. Changes to the household demographics may impact tenant eligibility under NRAS and must be verified at the time of the change to ensure continued eligibility. Who fills out the form? Part A of the tenant consent form must be completed by an approved participant, or an authorised agent of the approved participant like your property/tenancy manager. Applications completed by any other parties will not be considered by the department. Part B of the tenant consent form must be completed by all adult tenants and independent minors of the household. All adult tenants and independent minors are required to sign the Tenant Consent Form signature page. Please ensure each tenant signs and completes the signature page (page 10). Why is information collected? Information about you, and your household, is collected in this form and any additional or supporting information to confirm your eligibility to rent an NRAS property. It may be used to better direct resources to areas of need and improve its services. The information may also be provided to state or territory governments for the same purpose. 2 Protection of information The approved participant and the department, as the persons responsible for collecting the information in this form and any additional or supporting information, are required to observe the Australian Privacy Principles under the Privacy Act 1988. This means that this form must: tell you why the information is needed (i.e. to enable the department to assess your eligibility to lease an NRAS property and to provide additional information for assessing the rental eligibility status); tell you what will happen to your information and who it will be given to (i.e. the approved participant will provide the information to the department and the department may give the information to any other parties the department determines appropriate to achieve the objectives of the Scheme). In addition, the approved participant and the department must: store the information securely; only use the information for the purpose it was obtained; only pass your information to other parties when the law allows or requires it. The department sometimes provides information about people who are accessing Australian Government funded services to other Government departments and researchers. When this happens, only limited information is made available, and the department removes all details that could identify you, e.g. your names and your employer's name. Any other Australian Government departments, state and territory governments and Australian researchers who are given access to the information must also observe the Australian Privacy Principles (or equivalent) when handling the information. The Australian Privacy Commissioner can investigate allegations of improper collection, use and disclosure of personal information by Government departments. For more information about how the department handles personal information please see the department's privacy policy at www.dss.gov.au/privacy-policy. The department's privacy policy contains information about how an individual can seek access to or correction of personal information held by the department. The policy also provides information about how an individual can make a privacy complaint. Obligations of your approved participant/housing provider The approved participant must verify that the gross annual income (income from all sources before tax is applied) of all occupants that reside in an NRAS approved rental dwelling is within the household eligibility threshold for your household composition. Your income is reviewed annually. The initial verification must be conducted by the approved participant/property/tenancy manager prior to you entering into a lease or rental agreement for the dwelling. Please note that you will cease to be an eligible tenant if your household's combined gross annual income exceeds the approved income threshold by 25 per cent or more in two consecutive eligibility years. The approved participant must ensure that they comply at all times with the landlord, tenancy, building and health and safety laws of the state or territory and local government area in which the dwelling is located. The approved participant must provide an NRAS approved rental dwelling at a rate at least 20 per cent below the assessed market rent of the property. 3 The approved participant may review the rent charged for your property in line with the landlord, tenancy and local government laws in your relevant state or territory. However, any change in rent must ensure that each charge of rent for the dwelling is at least 20 per cent below the market value rent for the property. The approved participant must keep and maintain all records used to verify your eligibility to lease an NRAS dwelling, methodology for determining market rent value and rent charged, and information and details specifically requested by the department for five years. Important information The approved participant or property/tenancy manager is responsible for completing the following questions on the Tenant Demographic Assessment and Consent Form: Part A Question 1* - Dwelling ID Question 2* - Lease details Question 3* - Gross household income Question 4* - Rent details Declaration* - Signed by Approved participant or property/tenancy manager * denotes mandatory questions The tenant is responsible for completing the following questions on the Tenant Demographic Assessment and Consent Form: Part B Question 5* - Age composition of household Question 6* - Household demographics Question 7* - Sources of income Question 8 - Sources of income evidence Question 9 - Studying or training Question 10 - Prior living arrangements Tenant consent form* - all tenants are required to sign the form * denotes mandatory questions Further information Further queries about this form can be sent to nras@dss.gov.au 4 Tenant Demographic Assessment Form PART A Dwelling and Lease details Approved Participant/Housing provider to complete Questions 1 to 4 and declaration 1. Dwelling ID* (* denotes mandatory question) Dwelling ID number * 2. Lease details* Start and end date of current lease*(for existing tenants only) New Lease dates * From: From: Ongoing lease? Yes (Circle as appropriate) What dates do changes in the From: Tenant Demographic Assessment (TDA) start from? * To: To: No To: 3. Gross household income* (as assessed by approved participant or property/tenancy manager). a. For new tenants: Gross household Income (before tax) Amount What was the annual gross household income for the 12 months prior to entry $ into this dwelling? * Number of residents receiving Commonwealth Rent Assistance b. For existing tenants: Gross household Income (before tax) Amount What is the annual gross household income before tax for the last $ 12 months? * Number of residents receiving Commonwealth Rent Assistance 5 4. Rent details* What is the market value rent for the dwelling, including the NRAS market rent index (CPI) $ if applicable? * What is the current rent charged? * $ Approved participant or property/tenancy manager declaration* I (name of authorised officer) Of (approved participant or housing provider name) have explained to the tenant, and I believe the tenant to understand: all of the information at pages 1-4 of this form; that the personal information the tenant has been asked to provide is collected for the purpose of determining access to and delivery of affordable rental accommodation under the Scheme; and that, as the approved participant or housing provider, I will be required, from time to time, to disclose some or all of the tenant's personal information to the Australian Government, and may also be required to disclose some or all of that information to other government departments and researchers as directed by the Australian Government. Officer signature Date: 6 Part B Tenant Consent Form By completing this form you as the tenant are providing consent to the collection and use of any personal information contained in this form, and in any additional or supporting information and documentation provided to the approved participant during the course of the tenancy to determine your eligibility to lease a property under the Scheme. This consent covers use by the approved participant and the department to use your personal information for the purpose of the Scheme. Tenant to complete Questions 5 to 10 and consent form 5. Age composition of household* What are the ages of all residents in your household? * Age Number of household residents (please indicate the number of tenants for each relevant age group for each relevant tenant) 0 4 years 5 17 years 18 54 years 55 & over 6. Household demographics* Household demographics Number of sole parents * Number of independent minors * (Independent minors are those persons aged under 18 years and residing in the household but living independently, i.e. not financially dependent on an eligible tenant over the age of 18 years) Number of couples* Number of residents with a disability Number of residents who are Aboriginal and/or Torres Strait Islander peoples Number applicable 7 7. Sources of income* (It is not mandatory to identify the income source, but it is mandatory to provide the housing provider with evidence of household income in order to verify your eligibility to rent an NRAS approved rental dwelling.) What is the main source of income for each resident in the household? Income source Number of residents Government Pensions and Allowances Self Employed Superannuation or annuity Wages/Salaries (Private Sector) Wages/Salaries (Public Sector) Wages/Salaries (Community Sector) Other Sources 8. Sources of income evidence What type of evidence was provided by the tenants to support the household income? (Evidence of household income may be provided at the time this form is completed or it may be provided as applicable, during the period of tenancy) . What evidence did you provide to the Approved participant or property/tenancy manager to support the income declared as above. Please indicate against each relevant category the types of evidence the household has provided to support the household income. Payslip Tick if evidence is provided when the form is completed Tick if evidence will be provided later Tax Assessment Centrelink Statement Bank Statement Superannuation Statement Other (please list) e.g dividend statement, foreign income, net income from business Other - Other Other - 8 9. Studying or training How many residents of the household are currently studying or training? Studying or training Number of residents Apprentices or traineeships Primary or secondary students Tertiary students (university or technical college) 10. Prior living arrangements Prior to this lease, what were the living arrangements of all household residents? Living arrangements Number of residents Home being purchased Home fully owned Homeless Living with family or friends Other Rented Real Estate Agent Rented - State & Territory Housing Authority Supported accommodation 9 Tenant consent form Signature Page* (all adult tenants and independent minors of the household are required to sign this page, please reprint this page for each tenant and complete). NRAS Dwelling ID: (if known) The personal information you are asked to provide in this form or as additional or supporting information during your period of tenancy, is collected by the approved participant/property/tenancy manager to enable the approved participant or housing provider to determine (and the department to verify) your eligibility to lease a property under the Scheme and to assist the Australian Government to find out more information about who is accessing its services. The approved participant or housing provider will be required to collect your personal information and provide it to the department. The approved participant, housing provider and the department all may be required, from time to time, to pass some or all of your personal information to other Australian Government departments and researchers however will not be disclosed to other agencies. I (name of tenant/s) Of (address) In relation to my personal information contained in this form, and in the additional or supporting documentation provided during the course of my tenancy, I give my consent for the approved participant or housing provider responsible for managing the allocation covering my rental dwelling to collect my personal information for the purposes described in this form and in accordance with the objects of the Scheme. I also give my consent for the approved participant or housing provider to disclose on my behalf to the Australian Government, or to other government departments and researchers as directed by the Australian Government, some or all of my personal information as collected in this form or any additional or supporting information as collected during the course of my tenancy. I also acknowledge the disclosure of some or all of my personal information to the Australian Government and its use will occur for the purpose of assisting the Australian Government to conduct research and report its performance under the Scheme. I also agree, in the event the allocation covering my rental dwelling is transferred to another approved participant, my details may be provided to the gaining approved participant. Should I provide further personal information related to this form, or for the purposes of NRAS, I consent for my personal information to be handled in accordance with the above. Tenant/s signature Date: This consent form will be retained by your approved participant or housing provider, and may be sighted by the Australian Government, in order to verify your eligibility to lease a property under the Scheme. 10 Tenant consent form Signature Page* (all adult tenants and independent minors of the household are required to sign this page, please reprint this page for each tenant and complete). NRAS Dwelling ID: (if known) The personal information you are asked to provide in this form or as additional or supporting information during your period of tenancy, is collected by the approved participant/property/tenancy manager to enable the approved participant or housing provider to determine (and the department to verify) your eligibility to lease a property under the Scheme and to assist the Australian Government to find out more information about who is accessing its services. The approved participant or housing provider will be required to collect your personal information and provide it to the department. The approved participant, housing provider and the department all may be required, from time to time, to pass some or all of your personal information to other Australian Government departments and researchers however will not be disclosed to other agencies. I (name of tenant/s) Of (address) In relation to my personal information contained in this form, and in the additional or supporting documentation provided during the course of my tenancy, I give my consent for the approved participant or housing provider responsible for managing the allocation covering my rental dwelling to collect my personal information for the purposes described in this form and in accordance with the objects of the Scheme. I also give my consent for the approved participant or housing provider to disclose on my behalf to the Australian Government, or to other government departments and researchers as directed by the Australian Government, some or all of my personal information as collected in this form or any additional or supporting information as collected during the course of my tenancy. I also acknowledge the disclosure of some or all of my personal information to the Australian Government and its use will occur for the purpose of assisting the Australian Government to conduct research and report its performance under the Scheme. I also agree, in the event the allocation covering my rental dwelling is transferred to another approved participant, my details may be provided to the gaining approved participant. Should I provide further personal information related to this form, or for the purposes of NRAS, I consent for my personal information to be handled in accordance with the above. Tenant/s signature Date: This consent form will be retained by your approved participant or housing provider, and may be sighted by the Australian Government, in order to verify your eligibility to lease a property under the Scheme. 10 Tenant consent form Signature Page* (all adult tenants and independent minors of the household are required to sign this page, please reprint this page for each tenant and complete). NRAS Dwelling ID: (if known) The personal information you are asked to provide in this form or as additional or supporting information during your period of tenancy, is collected by the approved participant/property/tenancy manager to enable the approved participant or housing provider to determine (and the department to verify) your eligibility to lease a property under the Scheme and to assist the Australian Government to find out more information about who is accessing its services. The approved participant or housing provider will be required to collect your personal information and provide it to the department. The approved participant, housing provider and the department all may be required, from time to time, to pass some or all of your personal information to other Australian Government departments and researchers however will not be disclosed to other agencies. I (name of tenant/s) Of (address) In relation to my personal information contained in this form, and in the additional or supporting documentation provided during the course of my tenancy, I give my consent for the approved participant or housing provider responsible for managing the allocation covering my rental dwelling to collect my personal information for the purposes described in this form and in accordance with the objects of the Scheme. I also give my consent for the approved participant or housing provider to disclose on my behalf to the Australian Government, or to other government departments and researchers as directed by the Australian Government, some or all of my personal information as collected in this form or any additional or supporting information as collected during the course of my tenancy. I also acknowledge the disclosure of some or all of my personal information to the Australian Government and its use will occur for the purpose of assisting the Australian Government to conduct research and report its performance under the Scheme. I also agree, in the event the allocation covering my rental dwelling is transferred to another approved participant, my details may be provided to the gaining approved participant. Should I provide further personal information related to this form, or for the purposes of NRAS, I consent for my personal information to be handled in accordance with the above. Tenant/s signature Date: This consent form will be retained by your approved participant or housing provider, and may be sighted by the Australian Government, in order to verify your eligibility to lease a property under the Scheme. 10 TENANT INCOME ASSESSMENT Dwelling ID:________________________ OFFICE USE ONLY Assessment Date:_________________________ TENANT 1 YES Company: Company: Company: Company: NAME:______________________________________________________________________ EMPLOYMENT & WAGES NO Please detail your employment circumstances for the last 12 months Please attach 3 x most recent payslips and PAYG summary. Date Employment Commenced: Date Employment Ceased: Date Employment Commenced: Date Employment Ceased: Date Employment Commenced: Date Employment Ceased: Date Employment Commenced: Date Employment Ceased: CENTRELINK Please attach both 1. Centrelink Income Statement 2. Twelve (12) months Centrelink Payment History (Gross Payments) BANK INTEREST Please attach bank statement (proof of Interest earned) YES NO YES NO CHILD SUPPORT/MAINTENANCE Please attach Child Support Statement YES NO FOREIGN PENSIONS Please attach Statement FOREIGN INCOME As required (please attached proof of income) YES NO YES NO FINANCIAL SUPPORT Please attach Statutory Declaration stating period of financial support & amount received (i.e. food, clothes, rent, etc) BUSINESS INCOME Please attach letter from Accountant/tax return/BAS statement YES NO YES NO OTHER INCOME As required (i.e. rental income, scholarships, dividends, superannuation etc) YES NO Total amount received $ __________________ Fortnightly Date of Grant: __________________________________ Total interest $ __________________________ Annually Total maintenance $ ______________________ Annually Total pensions $ _________________________ Annually Total amount received $ _________________________ ________________________Annually/Fortnightly/Weekly Total support $ __________________________ Annually Total amount received $ ___________________ Annually Total income $ ___________________________Annually Source of income: _______________________________ TOTAL ANNUAL GROSS INCOME $ ________________________________ I acknowledge upon signing this document that I have disclosed all income sources for the 12 month period prior to the date of my application and that all information is true and correct. I agree that by signing my signature electronically, I accept to be bound to this declaration and any terms and conditions mentioned in this agreement. DATE: TENANT SIGNATURE: TENANT INCOME ASSESSMENT Dwelling ID:________________________ OFFICE USE ONLY Assessment Date:_________________________ TENANT 2 YES Company: Company: Company: Company: NAME:______________________________________________________________________ EMPLOYMENT & WAGES NO Please detail your employment circumstances for the last 12 months Please attach 3 x most recent payslips and PAYG summary. Date Employment Commenced: Date Employment Ceased: Date Employment Commenced: Date Employment Ceased: Date Employment Commenced: Date Employment Ceased: Date Employment Commenced: Date Employment Ceased: CENTRELINK Please attach both 1. Centrelink Income Statement 2. Twelve (12) months Centrelink Payment History (Gross Payments) BANK INTEREST Please attach bank statement (proof of Interest earned) YES NO YES NO CHILD SUPPORT/MAINTENANCE Please attach Child Support Statement YES NO FOREIGN PENSIONS Please attach Statement FOREIGN INCOME As required (please attached proof of income) YES NO YES NO FINANCIAL SUPPORT Please attach Statutory Declaration stating period of financial support & amount received (i.e. food, clothes, rent, etc) BUSINESS INCOME Please attach letter from Accountant/tax return/BAS statement YES NO YES NO OTHER INCOME As required (i.e. rental income, scholarships, dividends, superannuation etc) YES NO Total amount received $ __________________ Fortnightly Date of Grant: __________________________________ Total interest $ __________________________ Annually Total maintenance $ ______________________ Annually Total pensions $ _________________________ Annually Total amount received $ _________________________ ________________________Annually/Fortnightly/Weekly Total support $ __________________________ Annually Total amount received $ ___________________ Annually Total income $ ___________________________Annually Source of income: _______________________________ TOTAL ANNUAL GROSS INCOME $ ________________________________ I acknowledge upon signing this document that I have disclosed all income sources for the 12 month period prior to the date of my application and that all information is true and correct. I agree that by signing my signature electronically, I accept to be bound to this declaration and any terms and conditions mentioned in this agreement. DATE: TENANT SIGNATURE: TENANT INCOME ASSESSMENT Dwelling ID:________________________ OFFICE USE ONLY Assessment Date:_________________________ TENANT 3 YES Company: Company: Company: Company: NAME:______________________________________________________________________ EMPLOYMENT & WAGES NO Please detail your employment circumstances for the last 12 months Please attach 3 x most recent payslips and PAYG summary. Date Employment Commenced: Date Employment Ceased: Date Employment Commenced: Date Employment Ceased: Date Employment Commenced: Date Employment Ceased: Date Employment Commenced: Date Employment Ceased: CENTRELINK Please attach both 1. Centrelink Income Statement 2. Twelve (12) months Centrelink Payment History (Gross Payments) BANK INTEREST Please attach bank statement (proof of Interest earned) YES NO YES NO CHILD SUPPORT/MAINTENANCE Please attach Child Support Statement YES NO FOREIGN PENSIONS Please attach Statement FOREIGN INCOME As required (please attached proof of income) YES NO YES NO FINANCIAL SUPPORT Please attach Statutory Declaration stating period of financial support & amount received (i.e. food, clothes, rent, etc) BUSINESS INCOME Please attach letter from Accountant/tax return/BAS statement YES NO YES NO OTHER INCOME As required (i.e. rental income, scholarships, dividends, superannuation etc) YES NO Total amount received $ __________________ Fortnightly Date of Grant: __________________________________ Total interest $ __________________________ Annually Total maintenance $ ______________________ Annually Total pensions $ _________________________ Annually Total amount received $ _________________________ ________________________Annually/Fortnightly/Weekly Total support $ __________________________ Annually Total amount received $ ___________________ Annually Total income $ ___________________________Annually Source of income: _______________________________ TOTAL ANNUAL GROSS INCOME $ ________________________________ I acknowledge upon signing this document that I have disclosed all income sources for the 12 month period prior to the date of my application and that all information is true and correct. I agree that by signing my signature electronically, I accept to be bound to this declaration and any terms and conditions mentioned in this agreement. DATE: TENANT SIGNATURE:Acrobat PDFMaker 20 for Word Adobe PDF Library 20.6.66