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 hold a time-limited visa for the purpose of seeking asylum, protection or safe haven in Australia.
•	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.
•	You agree to enter into a loan repayment agreement with Housing ACT.	
•	You must complete all sections of this application form, including nil responses.
•	Your application must be signed by all applicants.
•	Housing ACT staff must sight original documentation to support your application, including identity, residency status, educational enrolment, income and assets. 
•	You must provide proof of income documentation from your employer and/or Department of Human Services (Centrelink). 
•	If self-employed, you must provide your most recent tax return, or a current profit and loss statement and balance sheet certified by a qualified accountant.
•	Lodging your application in person will assist in an earlier assessment. Alternatively, you can post your application (see below).	

If you have any questions about your eligibility for a rental bond loan, or how to complete this form, please contact Housing and Community Services on 133 427, or:
Attend in person	Write to us:
Nature Conservation House	Housing ACT
Corner Benjamin Way and Emu Bank	Locked Bag 3000
Belconnen  ACT  2617	Belconnen  ACT  2616	

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 – please telephone 133 427.
If English is not your first language and you require the Translating and Interpreting Service – please telephone 131 450.
If you are deaf or hearing impaired and require the Text Telephone (TYY) Service – please telephone 133 677 then ask for 133 427.

	

Personal Details
	Applicant 1	Applicant 2	
1	Title (please circle)	Mr	Mrs	Miss	Ms       
Other…………………………………………..	Mr	Mrs	Miss	Ms       
Other…………………………………………..	
2	Given Name(s)			
	Surname			
3	Former  Surname (if applicable)			
4	Date of Birth	…..... /…..... /….....	…..... /…..... /….....	
5	Relationship to other Applicant (if applicable)			

6	Are you an Australian citizen or permanent resident? 		Yes			 No	
If no, what is your residency status? 
………………………………………………………		Yes		  No	
If no, what is your residency status? 
………………………………………………………	
7	Current residential address			
8	Postal  Address (if different to address at 7) 			
9	Telephone Number	(Home) 	…………………………………
(Work) 	…………………………………
(Mobile) 	…………………………………	(Home) 	…………………………………
(Work) 	…………………………………
(Mobile) 	…………………………………	
10	Email Address			
11	Do you live or work or are you enrolled to study in the ACT?	Live		Yes		No	 Live		Yes		No	
		Work		Yes		No	 Work		Yes		No	
		Study		Yes		No	 Study		Yes		No	
12	Have you received any assistance from Housing ACT?	  	Yes		 No 
 If yes, was this for a Bond Loan or 
 Rented Property? (please circle)
Account Number …………………………
Address ………………………………………
……………………………………………………	   	Yes	   No
 If yes, was this for a Bond Loan or 
 Rented Property? (please circle)
Account Number …………………………
Address ………………………………………
…………………………………………………… 	
13	Do you owe any money to Housing ACT?	  	Yes	  No	  	Yes	  No	

Question 14   *optional and for statistical purposes only
 14*	What is your cultural identify?	   Aboriginal	  
   Torres Strait Islander
   Aboriginal & Torres Strait Islander
   Other ……………………………………….	   Aboriginal	  
   Torres Strait Islander
   Aboriginal & Torres Strait Islander
   Other ……………………………………….	
	What is your country of origin? 			
	What is your main language?			

Question 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	$		$		

Question 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?	
Address
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Valuation
$  . . . . . . . . . . . . . . . . . . . . . . . . . . . .	
Address
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

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

TOTAL ASSET VALUE	$	$	

Question 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	
	
….... /….... /…...		
….... /….... /…...	
	
….... /….... /…...		
….... /….... /…...	
	
….... /….... /…...		
….... /….... /…...	

Question 18 – Other Contact
Please give details of a person who is not a member of your household who Housing ACT can contact if we are unable to contact you directly.
Name		
Address		
Telephone	(Home) 	………………………………… (Work) 	…………………………………
(Mobile)  …………………………………	

Question 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)	$  …………………………..	
Privacy Notice
Housing and Community Services (HACS) is obliged to handle your information in accordance with the Privacy Principles set out in the Information Privacy Act 2014.  We explain how your personal information is collected, used, shared, stored, accessed and corrected in our privacy policy:  http://www.communityservices.act.gov.au/home/full_privacy_statement/. The information you provide in this form will be used to assess your bond loan eligibility and for statistical purposes. If you do not consent to supply us with this information we may not be able to assess your bond loan eligibility. HACS will not use or disclose your personal information without your consent, unless required by law, or if you would reasonably expect us to use or disclose the information for a related purpose. If you believe that your personal information has not been handled appropriately, or that we have breached the Privacy Principles you can contact us at CSD.Privacy@act.gov.au or 
(02) 6207 6547 to lodge a complaint.

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 taken to:
Housing and Community Services
Nature Conservation House
Corner Benjamin Way and Emu Bank
Belconnen  ACT  2617
Telephone Enquiries –  13 34 27   

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)	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, Shooters	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 (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).			
	
sby:	Officer Name	Officer Signature

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

Employer Income Statement

Name of Employer		

Name of person giving Statement

	

Signature	
I certify that the details above are true and correct. I understand that Housing and Community Services may contact me to verify these details.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	

Date	

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

Telephone	

Email address	

Organisation stamp  or seal	

Address of Employer		
Position in the organisation		
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 cease employment?
………………………………………………………………………….	

What is the gross amount paid to the Employee in the last 26 weeks? 
Include overtime, commission, allowances and penalties.  
Note: if the Employee has been employed for less than 26 weeks, please report gross income for the relevant time period. 	$ ……………………………..

  	Over 26 weeks	    Over shorter period:
		…………………… weeks	

What is the current gross weekly amount paid to the Employee? 
Include 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 and Community Services 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 and Community Services may contact me to verify these details.

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