Disclosure Consent Form

NRH sometimes needs to exchange information with individuals or services to help manage your tenancy and to connect you with the right support. We only share information where necessary, and only with your consent – unless required or permitted by law.

This form lets you tell Northern Rivers Housing (NRH) who we can share information with, and what kind of information we can share.

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

Your Privacy and Rights

I have read and understood how my information may be used and shared.
*

Tenant Details

First Name *

Last Name *

Email Address *

Phone *

Your Property Address *

Street address *

City *

State *

Postcode *

Who Can We Share Information With?

Please list the people, services, or organisations you agree we can share information with, and tick the type of information that applies for each.

Click the ''Add new row'' button below for each additional individual, service or organisation.

Person / Organisation *

Contact Information

Type of Information you agree to share

Tenancy InformationContact DetailsSupport InformationOther (please specify below)

If you selected ''Other'' above, please specify the additional types of information you agree to share (and with whom) below:

Tenant Authorisation

I consent to NRH collecting, using, and sharing my personal information with the individuals and or organisations listed in this form, for the purposes stated, until I withdraw this consent in writing.

I understand that I may withdraw my consent at any time by providing written notice to NRH, and that doing so may affect the services and support I receive.

I understand why NRH may need to share or request information about me. I give permission for this information to be shared only with the people/services listed above and only for the reasons I have agreed to.

I confirm I understand and agree with the above. *

Tenant Signature *

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Date *

Please tell us you are human *

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