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Apply Housing Assistance Add

This document is a housing assistance application form for additional household members. It requests information such as the applicant's relationship to the primary applicant, name, gender, date of birth, citizenship/residency, income, assets, property ownership, and transportation. The form notes that the personal information collected will be used to provide housing assistance and assess grant funding applications, and that in limited circumstances some information may be disclosed to partner agencies or used for research/planning. It also provides information about the privacy policy.

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41 views1 page

Apply Housing Assistance Add

This document is a housing assistance application form for additional household members. It requests information such as the applicant's relationship to the primary applicant, name, gender, date of birth, citizenship/residency, income, assets, property ownership, and transportation. The form notes that the personal information collected will be used to provide housing assistance and assess grant funding applications, and that in limited circumstances some information may be disclosed to partner agencies or used for research/planning. It also provides information about the privacy policy.

Uploaded by

daryltosch
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Housing Assistance / Transfer Application

Household
Applicant Note: Complete and submit this form for each
member
additional household member not included in your
application. Applicants are people who will sign the
Additional household member tenancy agreement

What is your relationship with the primary applicant?

Primary applicant full name:

Alias:

Any other name you may be known as.


Gender: Date of birth: / / Country of birth:

Do you identify as: Aboriginal Australian South Sea Islander


Tick all that apply.
Torres Strait Islander Other cultural or linguistic background None

Centrelink reference number (CRN):

Department of Veteran Affairs reference number (DVA):

Citizenship/Residency details: Australian citizen Permanent resident


Not permanent resident Visa - what type?

Are you expecting a child? Yes No


If yes, expected due date:

Do you have a medical


condition or disability? Yes No
If yes, provide details:

What is your income? $ Frequency: Type:


Gross amount and type (wages,
pension, allowances, family $ Frequency: Type:
payments, interest, superannuation).

What are your assets?


Savings, investments, cash $ Type:
deposits, property trusts, shares,
bonds, debentures, superannuation $ Type:
- allocated pension or lump sum
payments, share from property sale

Do you own/part own property Yes No


in Australia or overseas?
This could include residential If yes, what type:
property, vacant land, industrial Address:
property, commercial property, live-
aboard boat, cabin, donga, caravan, % of property owned:
or manufactured/ transportable
home. Current property value:

Ownership date:
What type of transport do you use? Public Own Other (family and friends)
The Department of Housing is collecting personal information on this form to provide you with housing assistance or assess grant funding applications. This
is authorised by the Housing Act 2003. To assist you with your housing needs and services, relevant personal information may, in very limited and specific
circumstances, be disclosed to: partner agencies, service providers, agencies authorised by legislative provisions, and local governments and non-
governmental agencies that now, or will provide you with housing and/or support services. Limited personal information may be used for housing related
research, policy or planning functions. Unless authorised or required by law, your personal information will not be passed on to any other third party without
your consent. More information about the department’s privacy policy is available on our website at www.housing.qld.gov.au.

HAA-Additional 4.0 (09.08.2023)

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