Tenancy Termination form

Property you are applying for:*
Applicant Details
Title:*
- Mr
- Mrs
- Ms
First Name/s:*
Surname:
Date of Birth:
DD slash MM slash YYYY
Address:*
Home Number:
Mobile Number:
Work Number:
Email address:
Are you an Australian Citizen or Permanent Resident?
- Yes
- No
- Permanent Resident
- Other
Household Details (please list the names of ALL other household members that will be living with you)
Full Name Date of birth M/F Relationship
Tenancy History
How long have you lived at your current address?
How much rent do you pay per week?
Name of current landlord/Agent:
Landlord's contact number:
Tenancy History - Please provide details of your last three tenancies:
Address Start of Tenancy End of Tenancy
Are you or any member of your family related to an employee or Director of Bridge Housing?
- Yes
- No
How did you find out about this affordable housing program?
- Article
- Online
- Newspaper
- Word of Mouth
- Direct Marketing
- Other
Income and Assets
Are you currently employed?
- Yes
- No
Please provide details of your employment over the past 2 years:
Employer Gross weekly income Length of employment
Please provide information below on the total gross household income (i.e. before tax). List all members of your household over the age of 18 who receives income from any source (e.g. full time/part time/casual work, Centrelink income, investments, private pensions).
Name of household member Source of income Gross weekly income
Total gross weekly income
Do you own or part own any property (e.g. housing or land)
- Yes
- No
Please provide details:
If yes what is the reason you are unable to live in this property?
Affordable Housing Evidence Requirements Checklist
In order for Bridge Housing to consider your application for affordable housing you must provide the following evidence to support your application along with this signed completed checklist.
Have you provided:
Proof of Identity (You must provide TWO from the list below for each person over the age of 18 years listed on your application)
- Birth Certificate
- Marriage Certificate
- Current Passport
- Medicare Card
- Motor Vehicle Driver’s Licence
Proof of Citizenship/Residency (you must provide at least ONE from the list below for each person over the age of 18 years listed on your application). Note: You MUST be an Australian Citizen or Permanent Resident for this program
- Birth Certificate
- Current Australian Passport
- Current Passport from relevant country of not an Australian Citizen but a Permanent Resident
- Australian Citizenship Certificate
Proof of New South Wales (NSW) Residency Status (You must provide at least ONE form the list below for each person over the age of 18 years listed on your application)
- Current Motor Vehicle Driver’s Licence
- Current Utility Bill in your name (water, gas electricity)
- Current lease agreement
Proof of Income (You must provide ALL from the list below that is relevant for each person over the age of 18 years listed on your application)
- 6 weeks most current consecutive payslips
- Current Centrelink Income Statement or signed Centrelink Authorisation Form (If receiving an income from centrelink)
- Income tax return outlining total gross income for the previous 12 months
- Profit and Loss statement outlining total gross income for the previous 12 months (If self-employed)
Proof of Current Assets (You must provide ALL from the list below that is relevant for each person over the age of 18 years listed on your application)
- Current bank statement (or bank passbook) for all accounts showing transactions for the last 6 weeks
- Records of any cash, shares or term deposits
- Proof of assets (e.g. share certificates, market valuation of any property owned)
Proof of satisfactory tenancy (You must provide ALL from the list below)
- Letter or contact number from your current landlord or real estate agent confirming satisfactory tenancy
- Rental ledger from current landlord or real estate agent
Authority to Disclose Personal Information
I am aware that by signing this form I am giving my consent to Bridge Housing Limited to share my personal information to external parties including State and Commonwealth funding bodies and private owners for the purpose of assessing my eligibility for affordable housing. I understand that my personal information will be collected, stored, shared and discarded in accordance with the NSW Privacy Act 1998. I am aware that I can remove my consent at any time however, I understand that by doing so it may affect my ongoing housing in the program. Bridge Housing’s Privacy Policy describes how personal information about you is collected, stored, shared to external parties and discarded and is in accordance with the NSW Privacy Act 1998. A copy of this policy can be found here https://www.bridgehousing.org.au/data/pdfs/corporate_polices/Privacy_Policy.pdf
Name*
DOB
MM slash DD slash YYYY
Address
Signature
Date
DD slash MM slash YYYY
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Full Name	Date of birth	M/F	Relationship

Address	Start of Tenancy	End of Tenancy

Employer	Gross weekly income	Length of employment

Name of household member	Source of income	Gross weekly income

Tenancy Termination form

Applicant Details

Tenancy History

Income and Assets

Affordable Housing Evidence Requirements Checklist

Authority to Disclose Personal Information