Part A - Application for Rentstart Bond Loan DCJ3049A

Application for Rentstart Bond Loan

DCJ3049A 02/24 Page 1 of 5

Please make sure you have read Part E of the Rentstart application form which is available from any Homes NSW office, or

community housing provider participating in Housing Pathways, or from the DCJ website at DCJ.nsw.gov.au/housing.

Two forms of identification (e.g. driver’s licence, passport OR confirmation of identification signed by your real estate agent

or a government employee)

Please provide all the information listed below for yourself and each person 18 years or over in your household.

Send your completed application to email: [email protected]

Your application must include details of all people to be housed, including children. Each household member 18 years or over MUST

complete an Additional Persons form.

This form should be read with the ‘Private Rental: Documents You Need’ fact sheet. A copy of this is available from the DCJ website

DCJ.nsw.gov.au/housing

Statements for your bank accounts for the last four weeks (displaying history of transactions or savings bank passbook)

Completed Property Information Form (Part C - to be completed by your real estate agent or landlord)

Proof of income - your income confirmation details MUST be current. You will need to send proof of income with your

application, unless your sole income is from Centrelink. If this is the case, you can sign the Centrelink release of information

section on page 4. Proof of income includes pay slips, they must show Year to Date (YTD) salary figures. If you are unable to

provide the YTD figures, four current payslips need to be shown, or you can have your employer complete an Income from

Employment form (Part D)

Proof of current assets

Passport or current visa (if you are not an Australian Citizen)

(for example: a Notice of Termination from your current agent/landlord, a medical certificate, letter from your support agency )

Note: We will not be able to process an incomplete application.

Checklist: Have you completed (and signed where relevant)

Once your completed application is received, we will contact you on the phone number that you have provided in this

application form. If you have provided a mobile number, an SMS will be sent within four hours to advise we have

received your application. If you do not provide complete information, processing your application will be delayed.

Homes NSW will assess your application in one working day (24 hours). If you have not received a response after one

working day (24 hours), please call 1800 422 322.

IF YOU ARE EMAILING THIS FORM, PLEASE DO NOT RETURN THIS PAGE.

Rentstart hours of operation

Mon - Fri 8.00am - 6.00pm

Sat 9.00am - 5.00pm

Phone 1800 422 322

Postal Address

Housing Contact Centre

Locked Bag 7150

Liverpool BC NSW 1871

Part A - Application for Rentstart Bond Loan form

Part B - Additional Persons form - if there are additional people aged over 18 years to be housed with you

Part C - Property Information form - to be completed by the real estate agent or property owner

Part D - Income from Employment form or payslips - if you are employed

Part E - Bond Loan Agreement - you must read and understand the Terms and Conditions of the Rentstart Bond

Loan before you apply

Authority for Bond Loan Deduction - if you are in receipt of any form of Centrelink payments, an Authority must be

submitted with your application

1. Details of main applicant

Given name(s)

Town/Suburb

Postcode

Current residential address

Contact number

Email address

Centrelink Reference Number (if applicable)

Last name

or family name

Sex

Male

Female

3. Do you need an interpreter when

dealing with Homes NSW?

This includes an interpreter for people

with a hearing or speech impairment

Yes

give details

DD/MM/YYYY

Date of birth

4. In what country were you born?

5. What is your current citizenship status?

Australian citizen (Australian born or obtained citizenship)

Permanent resident

Sponsored migrant

Refugee status

Asylum seeker with bridging visa

DD/MM/YYYY

Date of arrival

in Australia?

What is your visa

subclass number?

6. Are you of Aboriginal or Torres Strait

Islander origin?

Yes

give details

No Go to Q.7

Aboriginal

Torres Strait Islander

Aboriginal and Torres Strait Islander

Part A - Application for Rentstart Bond Loan

2. What is the main language you speak

at home?

Other

give details

English

What language?

Page 2 of 5 DCJ3049A 02/24

Title

Mr, Mrs, Ms, Miss, Mx

1. Details of main applicant

7. Have you been homeless within

the last five years?

Yes

give details

No Go to Q.15

13. Where have you been staying?

(e.g. streets, hostel, backpackers,

friends, refuge, rented home etc.)

10. How long have you been homeless?

(please place a number in the box

within appropriate timeframe)

Day(s)

Week(s)

Month(s)

Year(s)

19. Do you or anyone to be housed with

you own or part own any property?

Yes

You need to complete the Details of Land or Property Ownership

form available on the DCJ website DCJ.nsw.gov.au/housing.

Yes

No Go to Q.9

8. How many times have you been

homeless within the last five years?

(please indicate the number of times

you have been homeless)

9. Are you homeless at the moment?

No Go to Q.11

Yes

11. Do you have somewhere safe to

stay tonight?

Yes

12. Are you at risk of becoming homeless

sometime soon?

14. When will you be leaving the

place where you are staying?

15. Is anyone on this application an

employee of Homes NSW?

Yes

Full name

17. What is the total amount of cash,

shares, term deposits, other assets

held by your household (if any)?

Paid

(weekly/fortnightly)

Deduction type

and amount

18. Do you have deductions made from

your household income?

(e.g. maintenance, child support)

Yes

give details

16. Have you had any previous assistance

from Homes NSW?

Yes

Part A - Application for Rentstart Bond Loan

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Part A - Application for Rentstart Bond Loan

Homes NSW will provide a Rentstart Bond Loan for up to 100% of the bond. However, clients are able to apply for less than 100% of

a bond, but not less than 25%. In exceptional circumstances, a small amount of advance rent may be provided. To be eligible, you

must have a significant reason for moving from your current accommodation such as a medical condition or eviction. We also

consider situations where you or a household members personal safety is at risk such as in cases of domestic violence or child abuse

or neglect. You must supply written supporting evidence such as legal documents or a doctor’s letter setting out how you meet the

requirements.

Additional Assistance

20. Do you wish to apply for additional

assistance? (supporting evidence must

be supplied)

Yes

What is the reason you need to move

from your current accommodation?

Household members under 18 years:

Name Date of Birth Country of Birth

Relationship to

Main Applicant

Does this child

receive Austudy,

ABStudy or Youth

Allowance? (Y/N)

DD/MM/YYYY

Page 4 of 5

More information about Centrelink Confirmation eServices is available on Centrelink’s website at

www.servicesaustralia.gov.au/cces.

Family name Given name(s) Date of birth

Centrelink

Customer

Reference

Number

Signature Date

DD/MM/YYYY

Income Confirmation Scheme Consent Authority

If you or anyone on this application wish to participate in the Centrelink Income Confirmation Scheme please complete

the consent form below.

This consent will be used for the sole purpose of authorising Centrelink to provide information to the Homes NSW to

assess your eligibility for concessions or services provided by Homes NSW.

If you do not want Centrelink to provide your information electronically to Homes NSW, you will need to obtain the

information required from Centrelink yourself and provide it to Homes NSW.

Please read and sign the consent and the declaration below:

• I authorise Homes NSW to use Centrelink Confirmation eServices to perform a Centrelink enquiry of my Centrelink

Customer details and concession card status in order for Homes NSW to determine if I qualify for a concession,

rebate or service.

• I authorise the Australian Government Department of Services Australia (the Agency) to provide the results of that

enquiry to Homes NSW.

• I understand that the Agency will use information I have provided to Homes NSW to confirm my eligibility for

concessions, rebates or services and will disclose to Homes NSW my personal information including my name,

address, concession card status, payment type, payment status, income, assets, one-off payments, deductions and

shared care arrangements.

• I understand that this consent, once signed, remains valid while I am a customer of Homes NSW unless I withdraw

it by contacting Homes NSW or the Agency.

• I understand that I can obtain proof of my circumstances/details from the Agency and provide it to Homes NSW so

that my eligibility for concessions, rebates or services can be determined.

• I understand that if I withdraw my consent or do not alternatively provide proof of my circumstances/details, I may

not be eligible for the concessions, rebates or services provided by Homes NSW.

DCJ3049A 02/24

Consent to Homes NSW

1. Pursuant to Section 71 of the Housing Act 2001 and the Privacy and Personal Information Protection Act 1998, I consent, direct

and authorise Homes NSW to disclose personal information regarding myself for the purpose of processing this application. This

consent shall include disclosure to the Rental Bond Board and any relevant estate agency.

2. I also authorise Homes NSW to collect personal information regarding myself from any third party for the purpose of processing this

application and direct such third party to provide to Homes NSW the information sought. This authority extends to and includes

collection of information from third parties arising from claims for bond at conclusion of the lease.

Part A - Application for Rentstart Bond Loan

Office use only - Documentation sighted and certified (Can be completed by a Homes NSW officer, licensed real-

estate agent or staff from other NSW Government agencies)

DD/MM/YYYY

Number

Position

Agency

Type

Citizenship

Name

Signature

Date

Is this a joint or shared

household?

Yes No

Is this client receiving a

Private Rental Subsidy?

Yes No

Declaration by applicant

I certify that the information I have given is true and correct.

a) I understood the instructions given on the form.

b) I declare all the information I have given is true and correct to the best of my knowledge.

c) I am aware the maximum penalty under the Housing Act 2001 for making a false statement or representations is a fine of $2,200.

d) I understand Homes NSW may refuse further assistance or prosecute me if I have made any wilfully false statements as a result

of which I obtain accommodation or financial benefit of any kind.

Sign here

Date

DD/MM/YYYY



Full name (please print)

I have read the Rentstart Bond Loan Terms and Conditions (Part E)

Please mark to confirm

Declaration from person assisting or completing this application on behalf of the applicant

Please sign below if you have complied with and you understand the following statements:

a) I filled in this form on the basis of the information the applicant gave me.

b) I have read out the form and the answers to the applicant who seemed to understand them.

c) I understand that monetary penalties including imprisonment for a period of up to six months may be imposed by a court if I have

made any wilfully false statement as a result of which I obtain accommodation or financial benefit of any kind.

d) I understand Homes NSW may refuse further assistance or prosecute me if I have made any wilfully false statements as a result

of which I obtain accommodation or financial benefit of any kind.

Sign here

Date

DD/MM/YYYY



Full name (please print)

I have understood the Rentstart Bond Loan Terms and Conditions (Part E)

Yes No

I have decided to seek independent expert advice to have the Terms and Conditions (Part E)

explained to me

I have read the Rentstart Bond Loan Terms and Conditions to the applicant (Part E)

Please mark to confirm

The applicant seemed to understand the Rentstart Bond Loan Terms and Conditions (Part E)

Yes No

I have assisted the applicant to seek independent expert advice to have the Terms and

Conditions (Part E) explained to them

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