Application for Rental Bond Loan

Office Use Only	

Application Number:	
Application Date:	

Officer Name:	
Time:	

Loan Account Number:	

Eligibility For A Rental Bond  Loan	
Instructions To Complete Application	
* 	You must live, work or be enrolled to study in the ACT.
* 	You must be an Australian citizen, permanent resident or Temporary Protection Visa holder.
* 	You meet the current income limits.
* 	You do not have an interest in a residential property in Australia.
* 	You meet the current cash and asset limit.

* 	You do not have any outstanding debts with Housing ACT.

* 	The rental bond has not been paid.
* 	You are able to satisfactorily meet the obligations and payments required in sustaining a tenancy in a private rental property;
* 	Payment of the rental bond loan is
conditional on the applicant(s) entering into a loan repayment agreement with Housing ACT.	* 	All sections of the Application must  be completed, including nil responses.
* 	The Application must be signed by all applicants.
* 	Original documents must be provided to
establish identity, residency status, enrolment in a course of study, income and assets.
* 	Your employer and/or Centrelink or other income provider must complete the proof of income forms.
* 	If self-employed, a current profit and loss statement and balance sheet certified by a qualified accountant, or your most recent income tax return must be provided.

* 	Lodging your application in person will assist in an earlier assessment. Alternatively, you may fax or post your application to the address on page 4.	

If you have any queries about  the eligibility criteria, or about  completing the
Application Form, please contact Gateway Services, Housing ACT.	

Accessibility
The ACT Government is committed to making its information, services, events and venues, accessible to as many people as possible.
If you have difficulty reading a standard printed document and would like to receive this publication in an alternative format – such as large print or audio – please telephone (02) 6205 0619.
If English is not your first language and you require the translating and interpreting services – please telephone 131 450.
If you are deaf or hearing impaired and require the TTY typewriter service – please telephone (02) 6205 0888.

	

Personal Details
	
Applicant 1	
Applicant 2	

1	
Title	
Mr	Mrs	Miss	Ms	
Mr	Mrs	Miss	Ms	

2	
Given Name(s)			
	
Surname			

3	
Former  Surname (if applicable)			

4	
Date of Birth	
. . . . . / . . . . . / . . . . .	
. . . . . / . . . . . / . . . . .	

5	
Relationship to other
Applicant (eg partner)			

6	
Are you a citizen or permanent resident of Australia? If No, what is your residency status?	
Yes	No

Status . . . . . . . . . . . . . . . . . . . . . . . .	
Yes	No

Status . . . . . . . . . . . . . . . . . . . . .	

7	
Current residential address			

8	
Postal  Address (if different from residential)			

9	
Telephone Number	
(h) . . . . . . . . . . . . . . . . . . . . . . . . . . . 
(w) . . . . . . . . . . . . . . . . . . . . . . . . . .
(mobile) . . . . . . . . . . . . . . . . . . . . . .	
(h) . . . . . . . . . . . . . . . . . . . . . . . . 
(w) . . . . . . . . . . . . . . . . . . . . . . . .
(mobile) . . . . . . . . . . . . . . . . . . . .	
10	Email Address			

11	
Do you live or work  or are you enrolled to study in the ACT?	Live	Yes	No

Work	Yes	No

Study	Yes	No	Live	Yes	No

Work	Yes	No

Study	Yes	No	

12	
Have you received any assistance from Housing ACT?	

Yes	No

If yes, Bond Loan or Rented Property? (please circle)

Account Number . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	

Yes	No

If yes, Bond Loan or Rented Property? (please circle)

Account Number . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	

13	
Do you owe any money to Housing ACT?	
Yes	No	

Yes	No	
All parts  of the following Question 14 are Optional

	

14  
	Indigenous Status      (statistical purposes only) 	Non-Indigenous    	 Aboriginal
Torres Strait Islander 
•	 Aboriginal and Torres Strait Island
	Non-Indigenous	Aboriginal
Torres Strait Islander	
			•	Aboriginal and Torres Strait Island

What is your Country of origin?			
	
What is your main language?			

15  Income
(Please list income from ALL sources and attach supporting documentation)
	
Applicant 1	
Applicant 2	
	
Amount	
Source	
Amount	
Source	

Gross Weekly  Income

(before tax)	
$		
$		
	
$		
$		
	
$		
$		
	
$		
$		
	
$		
$		

TOTAL WEEKLY  INCOME	
$		
$		

16  Value of Assets
(Please list ALL assets, including a description, and attach supporting documentation)
	
Applicant 1	
Applicant 2	
	Amount

	Description	Amount	Description	

(i)	
Bank Account	$		$		

(ii)	
Bank Account	$		$		

(iii)	
Bank Account	$		$		

(iv)	
Term Deposit	$		$		

(v)	
Term Deposit	$		$		

(vi)	
Vehicle(s) Car, Truck, Motorbike, Boat, Caravan etc – Show insured value, make, model, registration	$		$		

(vii)	
Shares, Stocks, Bonds, Other Investments	$		$		

(viii)	
Overseas Assets
(Specify)	$		$		

(ix)	
Other (Specify)	$		$		

(x)	
Other (Specify)	$		$		
	
Do you own or are you purchasing any residential property or land in Australia?	
Yes	No

Address
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Valuation
$  . . . . . . . . . . . . . . . . . . . . . . . . . . . .	
Yes	No

Address
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Valuation
$  . . . . . . . . . . . . . . . . . . . . . . . . . .	

TOTAL ASSET VALUE	$	$	

17  Household Details
Show details of everybody else who will be living in the home for which you need the Bond.

Name	
Date of Birth	
Name	
Date of Birth	
	
. . . . / . . . . / . . . .		
. . . . / . . . . / . . . .	
	
. . . . / . . . . / . . . .		
. . . . / . . . . / . . . .	
	
. . . . / . . . . / . . . .		
. . . . / . . . . / . . . .	

18  Other Contact
Please give details of a person who is not a member of your household whom Housing ACT can contact if we are unable to contact you directly.

Name		

Address		

Telephone	
. . . . . . . . . . . . . . . . . . . . . . . .. . . . (h)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . (w)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . (mobile)	

19  Property Details

Have you already chosen a property to rent?	
Yes	No	

If Yes, how much do you want to borrow?   (Maximum of 90% of property bond)	
$  . . . . . . . . . . . . .	

About the information you give.

Unless otherwise specified as optional, the personal information sought on this form is required under the Housing
Assistance Act 2007.

The information will be treated confidentially, and will be used to assess your eligibility for housing assistance, revenue collection, and for statistical purposes, and may be disclosed where required or authorised by or under law.

You may have access to the information at any time to ensure that it is still accurate, and correct it if necessary.

Declaration
I/we authorise the Commissioner for Social Housing, the Office of Rental Bonds, my/our Lessor/Agent and my/our employer/income  provider to exchange information about me/us, my/our tenancy and the bond relating to it.  I/we hereby declare that, to the best of my/our knowledge, all questions on this Application have been answered truthfully and correctly and all relevant information has been provided.
Applicant 1	Applicant 2

Signature(s)

Date	. . . . .. . . / . . . . . . . . / . . . . . . .	. . . . .. . . / . . . . . . . . / . . . . . . .

Completed Applications plus  supporting documents should be submitted to:

Gateway  Services
Nature Conservation House
Corner Benjamin Way and Emu Bank
Belconnen  ACT   2617
Telephone Enquiries – (02) 133 427   Facsimile – (02) 6207 1148

Office  Use Only	

Document Checklist
Each applicant  must supply  100 points  of identity.	
Documents for proof of identification / residency	Points	Applicant 1	Applicant 2	
Birth Certificate	70			
Citizenship Certificate	70			
Visa	70			
Passport (current or expired less than 3 years, not cancelled)	70			
Rates Notice	35			
Bills, eg electricity, telephone (one per institution only)	25 each			
Credit / Debit / ATM Card (one per institution only)	25 each			
Tertiary ID Card	40			
Primary/Secondary/Tertiary institution record within  last 10 years	25			
Secondary/Tertiary enrolment  notice	25			
Electoral Roll	25			
Public Service Employee ID Card	40			
Non Public Service Employee ID Card	25			
Other Government issue ID Card – sealed in plastic	40			
Government issue license or permit, eg Drivers, Shooter	40			
Other license or permit, eg foreign drivers	25			
Marriage Certificate	25			
Medicare Card	25			
Registration Certificate, eg car, boat	25			
Centrelink  / Pension Card	40			
Other acceptable document  that verifies  name and address or signature	25			
Total points  scored (minimum  100 points  per person)			
	
Documents for proof of income / assets	Applicant 1	Applicant 2	
Centrelink Income Statement (if applicable).			
If employed – Employer Income Statement covering previous 26 weeks.			
If self employed – current profit and loss statement and balance certified by a qualified accountant, or most recent tax return.			
Bank books or statements for all accounts.			
Letters or statements from Government agencies (other than Centrelink)  from which payment is received.			
Documents for other income or assets (such as share certificates, bond certificates, trust accounts and fixed term deposits, overseas pension or income).			
	
Completed by:	Officer Name	Officer Signature

. . . . . . / . . . . . . / . . . . .	

Employer Income Statement

Name of Employer		

Address of Employer		

Name of Employee		

Current Address of Employee		

When did the Employee commence work with the organisation?	

. . . . . / . . . . . / . . . . .	

Is the Employee still employed by the organisation?	
Yes	No

If No, when did the employee leave the organisation?

. . . . . / . . . . . / . . . . .	

What is the gross amount paid to the Employee in the last 26 weeks?  (including overtime, commission, allowances and penalties).  If the Employee has been employed for less than 26 weeks, the amount paid during that period.	

$ . . . . . . . . . . . . . . . . . . . . . .	

What is the current gross weekly amount paid to the Employee? (including overtime, commission, allowances and penalties if applicable).	

$ . . . . . . . . . . . . . . . . . . . . . .	

Name of person giving Statement		
Position in organisation		
Signature	I certify that the details above are true and correct.
I understand that Housing ACT may contact me to verify these details.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	
Date	
. . . . . / . . . . . / . . . . .	
Telephone		
Email address		
Organisation stamp  or seal		

	

Property Details
(To be completed by Lessor or Agent)

Details of Lessor or Agent	
Name of Lessor / Agency		
Contact Person		
Contact Address	
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	
Telephone		
Facsimile		
Email Address		

Details of Rental Property	
Address	
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	
Weekly Rent	
$ . . . . . . . . . . . . . . . . .	
Amount of Bond  required (Bond  only  - do not include rent in advance)	
$ . . . . . . . . . . . . . . . . .	
Has the Bond been paid?	
Yes	No	
Name/s on Tenancy  Agreement	
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	
Has the tenancy commenced?	
Yes	No

Date or proposed date of commencement.

. . . . . / . . . . . / . . . . .	

Signature of Lessor / Agent	I certify that the details above are true and correct.  I understand that Housing ACT may contact me to verify these details.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	
Date	
. . . . . / . . . . . / . . . . .