Application for Private rental bond assistance loan
Department of TERRITORY FAMILIES, HOUSING AND COMMUNITIES
02/24 | SF30
Page 1 of 6
Application for Private rental bond
assistance loan
This is an application for a bond assistance loan to assist you to rent a private rental property. The loan, if
approved, is provided by the Department of Territory Families, Housing and Communities. Private rental
bond assistance provides up to four (4) weeks rent as bond, and an optional two (2) weeks rent in advance.
You can ask someone to help you complete this form such as a friend, relative or supporting agency
worker. If you need an interpreter, please let your local Housing office know. The Department can
organise help from an interpreter to complete this form.
All household members 18 years and over applying for the private rental bond assistance loan must
provide copies of their photo identification, bank statements and other supporting documents.
When completing the form, please ensure you:
• read and answer all of the questions carefully
• show your answer with a tick () where there are boxes
• attach any supporting documents
• sign the declaration
• return this application form to your local Housing office; or you may send this via email to the
appropriate Housing office below:
o Darwin - DarwinClientServices.TFHC@nt.gov.au
o Tennant Creek – TFHC.BarklyHousing@nt.gov.au
o Katherine - ClientServices.Katherine@nt.gov.au
o Alice Springs - Clientservices.AliceS[email protected].au
o Nhulunbuy - ArnhemRemoteTenancy.tfhc@nt.gov.au
The Department will review your application and check it is complete. The Department will then assess
your eligibility for private rental bond assistance.
Incomplete applications or missing documents will delay assessment. The Department will inform you
of the outcome of your application in writing.
Please read the Private rental bond assistance fact sheet or contact your local Housing office for more
information.
Office use only
Group no
Previous group no (if applicable)
TRM reference no Received by
Application for Private rental bond assistance loan
Department of TERRITORY FAMILIES, HOUSING AND COMMUNITIES
02/24 | SF30
Page 2 of 6
Part A – Private rental bond assistance options
What private rental bond assistance
option are you applying for?
Four (4) weeks rent only; or
Four (4) weeks rent and two (2) weeks rent in advance
Part B – Applicant 1
Title
Mr Mrs Ms Miss Other:
Gender
Male Female Unspecified
First name(s)
Last name
Date of birth / /
Please provide details of any other names, if applicable
Residential address Postcode
Postal address
Postcode
Home phone
Work phone
Mobile phone
Email
Do you identify as Aboriginal or
Torres Strait Islander?
Aboriginal Torres Strait Islander
Do not identify as Aboriginal or Torres Strait Islander
Have you been diagnosed with a disability?
Yes No
Next of kin/alternative contact – please give details of a person we can call to get in contact with you
Full name
Relationship to applicant 1
Home phone
Work phone
Mobile phone
Email
Income and Asset details – You will need to attach support documents for each source of income and/or
assets. Please refer to the checklist located on the last page of this form.
Source of income
Gross amount
(before tax)
Assets
Gross
amount
(before tax)
or estimated
current value
Wages
Bank account(s)
Pension/allowance
Fixed term deposits
Self-employment
Shares investments (includes
accessible superannuation funds)
Workers compensation
Boat/caravan/any other
recreational vehicles
Application for Private rental bond assistance loan
Department of TERRITORY FAMILIES, HOUSING AND COMMUNITIES
02/24 | SF30
Page 3 of 6
Other
Property and land/any other
valuable saleable items
Part C – Applicant 2 (this may be a partner or other joint applicant)
Title
Mr Mrs Ms Miss
Other:
Gender
Male Female Unspecified
First name(s)
Last name
Date of birth / /
Please provide details of any other names, if applicable
Residential address
Postcode
Postal address
Postcode
Home phone
Work phone
Mobile phone
Email
Do you identify as Aboriginal
or Torres Strait Islander?
Aboriginal Torres Strait Islander
Do not identify as Aboriginal or Torres Strait Islander
Have you been diagnosed with a disability?
Yes No
Next of kin/alternative contact – please give details of a person we can call to get in contact with you
Full name
Relationship to applicant 2
Home phone
Work phone
Mobile phone
Email
Income and Asset details – You will need to attach support documents for each applicable income and/or
asset. Please refer to the checklist located on the last page of this form.
Source of income
Gross amount
(before tax)
Assets
Gross amount
(before tax)
or estimated
current value
Wages
Bank account(s)
Pension/allowance
Fixed term deposits
Self-employment
Shares investments (includes
accessible superannuation funds)
Workers compensation
Boat/caravan/any other
recreational vehicles
Other
Property and land/any other
valuable saleable items
Application for Private rental bond assistance loan
Department of TERRITORY FAMILIES, HOUSING AND COMMUNITIES
02/24 | SF30
Page 4 of 6
Part D – Household member details
Please provide details of all the people who will be living with you. You do not need to provide details of
applicant 1 or 2 again. If you require more space for household members, please write on another piece of
paper and attach it to this form.
Household member 1 2 3
Title
First name(s)
Surname
Relationship to you
(e.g. son, daughter)
Gender
Male Female
Unspecified
Male Female
Unspecified
Male Female
Unspecified
Date of birth / / / / / /
Aboriginal
Yes No Yes No Yes No
Torres Strait Islander
Yes No Yes No Yes No
Household member 4 5 6
Title
First name(s)
Surname
Relationship to you
(e.g. son, daughter)
Gender
Male Female
Unspecified
Male Female
Unspecified
Male Female
Unspecified
Date of birth / / / / / /
Aboriginal
Yes No Yes No Yes No
Torres Strait Islander
Yes No Yes No Yes No
Application for Private rental bond assistance loan
Department of TERRITORY FAMILIES, HOUSING AND COMMUNITIES
02/24 | SF30
Page 5 of 6
Disclaimer
The Department of Territory Families, Housing and Communities only collects personal information which is
reasonably necessary, or related to, its functions and activities. If you do not provide the Department with the
requested information, we may not be able to provide you with the services or assistance that you are seeking.
The information collected will be handled as outlined in our Privacy Policy, which is available on tfhc.nt.gov.au
or can be requested by contacting the Department. By providing your personal information in this form, you
consent to the collection, use, storage and disclosure of your personal information as described in our Privacy
Policy. You have a right to seek access or correction of any information we hold about you. If you have any
queries or concerns about how your personal information is collected and used, please contact the Legal and
FOI Unit on (08) 89992602.
Part E - Declaration
I/We: (Full names in BLOCK Letters)
• Understand that I/we may be prosecuted under the Housing Act 1982 of the Northern Territory
should I/we deliberately make a false or misleading statement in this application. Maximum penalty:
100 penalty units.
• Authorise the Department of Territory Families, Housing and Communities staff to confirm any
personal and financial background relevant to this application.
• Understand that I/we must advise the Department of Territory Families, Housing and Communities of
any changes to my/our circumstances (for example changes in income, contact details, or household
size) that may affect this application.
Applicant 1 signature
Date / /
Applicant 2 signature
Date / /
Authorisation between joint applicants
Under the Information Act 2002 (NT), the Department of Territory Families, Housing and Communities
cannot supply your personal information to anyone without your consent. If you wish to consent to the
release of information to your joint applicant, please complete the authorisation below.
We, (Full names in BLOCK LETTERS)
Consent and authorise the release of personal information as
joint
applicants.
Applicant 1 signature
Date
/ /
Applicant 2 signature
Date / /
Application for Private rental bond assistance loan
Department of TERRITORY FAMILIES, HOUSING AND COMMUNITIES
02/24 | SF30
Page 6 of 6
Checklist
Document
attached
The following are examples of documents you are required to provide to
support your application.
Office use
only check
(Staff to tick
as applicable)
Proof of identification
Pensioner concession card, Medicare card, driver licence, Keypass ID,
birth certificate, current passport or citizenship certificate for everyone
listed in the application. Photographic identification must be provided for
each lease signatory applying for Private rental bond assistance
Proof of Northern Territory residency
The document must:
• detail your full name
• be no more than a fortnight old at the time of submitting your
application
• be on official letterhead, remittance advice or provided direct from
the relevant authority.
Proof of custody for sole parents
Legal documents proving custody or a document issued by Centrelink
confirming custody arrangements.
Proof of marriage or de facto relationship
Not required if this documented on your Income Statement issued by
Centrelink.
Proof of custody/guardianship for dependents other than your own
children
This can be in the form of receipt of Centrelink Family Tax Benefit, Child
Maintenance Payments, and Carers Allowance.
Proof of household income
Centrelink Income Statements and/or payslips for the past thirteen (13)
weeks.
Current bank statements
Bank statements are required to show at least three (3) months of
transactions.
Statement of assessable assets
Most current valuation certificate or documents
Proof of loans against assets
Bank statements or loan documents
Further information
Further information about acceptable support documents can be found on the following fact sheets:
• Proof of Identification
• Proof of Income
• Private rental bond assistance
