Application for Review of Rental Subsidy

This form is applicable to Social Housing tenants only. Please use this form when there has been a change to household circumstances.

The Head Tenant must complete this form.

If you require assistance completing this form, please get in touch with us.

Note: This form has a 'Save and Complete later' option - scroll to the bottom of the page to complete the form at another time.

Privacy and Your Rights

NRH will store this information securely and keep it confidential. Your information will not be shared without your consent, except where required by law.

It will only be used:

For the purpose for which it was collected.
In line with our Privacy Policy and all legal obligations.

You have the right to update or withdraw this information at any time by contacting NRH.

I confirm that I have read and understand the above. *

Head Tenant Details

First Name *

Last Name *

Email Address *

Phone *

Property Address *

Street address *

City *

State *

Postcode *

Current Circumstances

Has anything in your household changed since your last rental subsidy review? *

Yes (please specify below)No

E.g., Has anyone moved in or out? Has anyone turned 18? Have any Centrelink or support payments changed? Has anyone commenced or ceased employment? Has anyone had a baby?

If Yes, please provide details

Date of the changePlease advise the date the change occurred

Please list ALL current household members, including the Head Tenant (add new row for each household member)

Full Name *

Date of Birth *

Relationship to Head Tenant *

Income Type (wages, Newstart, Age pension, etc.) *

Gross Weekly Amount received *

Total Savings or Investments *

Please list the household members above who have previously provided consent for NRH to check their Centrelink income details. Any household members who have not previously completed a Centrelink Multiple Consent Form with NRH is required to provide evidence of any Centrelink income received (e.g. Centrelink statement). Verification of all other sources of income must also be provided as supporting documents to this form. *

Is anyone in the household self-employed or have any share in the ownership of a business? *

Yes (please provide details below. A Profit & Loss Statement signed by a qualified accountant must be attached to this form). No

If Yes, please specify occupation or business

Attach Profit & Loss Statement

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Note: Profit & Loss Statement must be signed by a qualified accountant.

Do you or anyone in the household pay child support maintenance as a custodial parent? *

Yes (please provide details below. Note: Proof of payments must be attached to this form). No

Name of Custodial Parent

How is it paid (e.g. Child Support Agency) *

How much is paid each week?

Attach proof of child support payments

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Do you or anyone in the household own or part own any property including a house, unit, land or commercial property? *

Yes (please provide details below)No

If Yes above, please provide name of person

Address of the property

Street address

City

State

Postcode

What is the value of the property?

What is the weekly income from the property?

Upload Additional Supporting Documents here (e.g. Proof of other sources of income)

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Tenant Declaration

I understand that:

- There are penalties for giving false or misleading information.
- I may have to pay back money to NRH if my subsidy is changed or cancelled.

I declare that all the details I have given are true and correct to the best of my knowledge for every household member.
*

Head Tenant Signature *

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Date *

Let us know you are human *

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