Emergency Contact & Next of Kin

Why we ask for this information

We ask all tenants and residents to provide up to date emergency contact information.

This information helps us act quickly and appropriately in the event of an emergency, serious illness, or if we are unable to reach you.

Where possible, please list a family member, friend or trusted person - not a support or social worker.

Note: This form has a 'Save and Complete later' option - scroll tothe 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.

I understand that I can update or withdraw this information at any time by contacting NRH. *

Tenant Details

First Name *

Last Name *

Date of Birth

Email Address *

Phone *

Your Address *

Street address *

City *

State *

Postcode *

Emergency Contact Person Details

Emergency Contact - Full Name *

Emergency Contact - Relationship to you *

Emergency Contact - Phone *

Emergency Contact - Email *

Next of Kin Details

Next of Kin - Full Name *

Next of Kin - Relationship to you *

Next of Kin - Phone *

Next of Kin - Email *

Power of Attorney / Guardian (optional)

This helps us understand who is legally authorised to make decisions for you if required.

Have you appointed a Power of Attorney or Guardian? *

YesNoUnsure

If you have appointed a Power of Attorney or Guardian, please provide a copy of the legal documentation confirming this appointment. This helps us ensure we are speaking with and taking instructions from the correct person.

Please select your preferred option

Upload a scanned copy or photo of the documentProvide a certified copy in person at the Lismore Head Office Post a certified copy to our postal address (NRH, PO Box 145, Lismore, NSW 2480).

Attach documentation here

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Tenant Authorisation

I have read and understand the instructions given on this application form.  *

To be best of my knowledge the information provided in this form is true and correct.  

Tenant Signature *

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Date *

Let us know you are human *

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