Property owner/agent’s declaration form Housing SA

1 Property DETAILSR ental Property addressType of accommodationTENANCY DETAILST enancy start date Is this to replace an existing bond? Yes NoType of lease Periodic Fixed term Fixed term tenancy period Years MonthsTotal weekly rent for Property Total bond charged Property MANAGEMENT DETAILS Pick one landlord type and complete the relevant owner (an individual or a company)Surname First nameOR Company nameAddressPhone EmailSignatureReal estate agent Registered Community Housing Provider Other organisation Agency nameAddressPhone EmailContact personSignatureSuburb PostcodeName of tenantsShare of weekly rentOnly include those who contribute to the additional names if there are more than four $2.

2 $3.$4.$/ /$$Financial Assistance for sharers is based on equal shares, except if otherwise approvedAre you subletting the Property ? If yes, provide written approval from your NoAre you renting this Property to a family member? If yes, provide a Statutory declaration confirming you won t be living in the NoSuburb PostcodeAssistance is paid to the name registered by Land ServicesSuburb PostcodeProperty owner/ agent sdeclaration formHousing SAOffice use only Customer No: Customer No: Date received: / / A Property owner or agent completes this form. Return completed forms to Housing SA.

3 Completing this form doesn t automatically guarantee assistance for the complete an electronic Property owner/ agent s declaration form (EPOD) go to You can get more information online at or by phoning Housing SA on 131 JULY 2018 Rental premises (House/ flat/ unit)Rooming House (Boarding)No premium retirement villageCaravan Park (Van and site)