Tenancy

Bond refund form

› Use this form to get a bond refunded.
› All sections of this form must be completed to enable smooth processing of information.
› Make sure you fill in all the boxes that apply to you. Tenancy Services will be unable to release the tenants’ portion of the bond
until all tenants have signed the form and indicated how much each tenant is to receive.
› If your bond was lodged on or after 2 December 2024, please include the signature page of your tenancy agreement when you
send us this form. We use this to verify the signatures on this form.
› If you are using a pen to fill in this form, please print clearly. Do not sign this form until all information has been entered.
› Before you start, read the important information on the last page of this form.

1 Bond number 3533698-004

2 Tenancy address 11 Main Highway, Ellerslie, Auckland

3 Reason for refund

Tenant leaving
Decrease in rentNew weekly rent New total bond
Partial refund Disposal of goods Please ensure you have included a copy of the Tenancy Tribunal order which awards you the disposal of goods amount

Tenancy endingDate tenancy ended

DD MM YYYY

Reason for ending tenancy (optional)

4 Refund details Please countersign any alterations you make or your refund may be delayed. This section must be completed before any signatures are entered

Pay the landlord(s) 0.00 Pay the tenant(s) 3,400.00 Amount on hold 0.00 Total 3,400.00

Landlord’s reason(s) for claiming some or all of the bond Arrears Repairs Cleaning Outgoings Other

5 Landlord details
Landlord ID: 2566084 Contact phone 021977879 Other phone

Full name(s) or trading name Shaohua Lin

Bank account Reference

This must be a New Zealand bank account. To appear on your bank statement

Email
Landlord postal address (email will be first point of contact if provided)
Address line 1 33 Finn Place

Address line 2 Mt Wellington

City Auckland Postcode 1060

Landlord signature(s)

Date 21 03 2025
DD MM YYYY
By signing this form you agree
ree that the information you have provided is true and correct
 Bond number

6a Tenant 1 details
Haoyi yang
Full name

Tenant 1 to receive 3400 Tenant exit date Contact phone 0204813166

DD MM YYYY

Bank account 01 0129 0973225 00 Reference deposit refund

This must be a New Zealand bank account. To appear on your bank statement

Email [email protected]
Tenant 1 postal address (email will be first point of contact if provided)
Address line 1 3/232 bucklands beach road.

Address line 2 bucklands beach

Auckland 2012
City Postcode

Tenant 1 signature

Date 21 03 2025
DD MM YYYY
By signing this form you agree that the information you have provided is true and correct

6b Tenant 2 details

Full name Weijing Dong

0284611297
Tenant 2 to receive Tenant exit date Contact phone
DD MM YYYY

Bank account Reference

This must be a New Zealand bank account To appear on your bank statement

Email [email protected]

Tenant 2 postal address (email will be first point of contact if provided)

Address line 1 3/232 bucklands beach road

Address line 2 bucklands beach

Auckland Postcode 2012

City
Tenant 2 signature

03 2025
Date 26
DD MM YYYY
By signing this form you agree that the information you have provided is true and correct

If there are more than 2 tenants, use the Additional tenants bond refund form. Send them to us together.
Yes, an additional tenants bond refund form is attached.

BOND REFUND FORM PAGE 2

MB_TEN0002 02/25
Tenancy

If you need to add more tenants, use the Additional tenants bond refund form
and attach it to this form.

Privacy statement Refund details Any questions?

Personal information provided on this This section shows how you have All our forms and other information are
form will be held and used by the agreed the bond money will be paid out on our website at
Ministry of Business, Innovation and to the tenant, landlord or both. If the www.tenancy.govt.nz
Employment for the purposes of landlord wishes to claim some or all of If you have any questions about this
administering and enforcing the the bond money, they must indicate form or need more information about
Residential Tenancies Act 1986. It may the reason why using the tick-boxes. bonds, please Freephone 0800
also be used for carrying out customer If there is any amount that you cannot TENANCY (0800 83 62 62) or contact
surveys, public education and agree on, this should be written in us by email at
statistical analysis. We may ‘Amount on hold’. This amount will not www.tenancy.govt.nz/contact-us
occasionally provide your information be paid out until agreement is reached
to third parties to carry out this work or until a mediated/Tenancy Tribunal Ki te mea he pātai āu mō tēnei puka,
on our behalf. order is made. kei te pīrangi pārongo rānei mō te moni
here (bond), waea koreutu 0800
The personal information you supply If your bond was lodged on or after TENANCY (0800 83 62 62), whakapā
will not be used for any other reasons 2 December 2024, please include the rānei ki a mātou i te īmēra
unless permitted under the Privacy Act signature page of your tenancy www.tenancy.govt.nz/ contact-us
2020 (e.g. with your consent or for a agreement when you send us this
directly related purpose). The form. We use this to verify the ’A iai ni fesili e uiga i lenei pepa pe
information may also be provided to signatures on this form. mana’omia fo’i nisi fa’amatalaga
third parties where it is required or e uiga i le tupe fa’amau (bond),
Landlord refund details: The fa’amolemole telefoni mai i le numera
permitted by law. landlord(s) should complete this 0800 TENANCY (0800 83 62 62),
The personal information you supply section. pe feso’ota’i mai ile emeli
will be provided to all parties named on Landlord ID number: If you do not www.tenancy.govt.nz/contact-us
this form or on the bond record. know this number, leave the box blank. 萴䖺僗♳⛰⪩◇儖辐劲亠ꪫ氳橎ꠋ
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bank account details on this form, you should complete this section. ♜
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information held by us at any time. For want your refund portion to be paid www.tenancy.govt.nz/contact-us
more information on the access to or directly to them. You should get their If you have questions about your rights
correction of personal information consent first. and obligations when renting call our
visit: www.tenancy.govt.nz/about- tenancy information line Freephone:
tenancy-services/privacy
Definitions 0800 TENANCY (0800 83 62 62)
Bond number: This is the bond number
Address information Send us your form
for the tenancy address. It is on all our
By providing us your contact details letters to you about this rented Email: [email protected]
you are authorising Tenancy Services property. If you do not have it please Post: Tenancy Services
to contact you. contact us. PO Box 50445
We collect this information so we can Reason for refund Porirua 5240
contact you about this bond and When we receive your form, we will
minimise any delays in paying out/ Tenant leaving: at least one tenant on
a multi-tenanted tenancy is leaving and update the bond record and send you
refunding the bond when the tenancy confirmation that this has been done.
finishes. some of the bond is to be refunded.

If you provide an email address, we Decrease in rent: some of the bond is

will use this as the primary way to to be refunded to parties because of a
contact you. decrease in rent.
Partial refund: some of the bond is to
Date tenancy ended be refunded to parities.
It is important that you include the Disposal of goods: money received
date the tenancy finished, as agreed through disposal of goods is refunded
between the tenant and the landlord. to the parties.
This date can affect the way the bond Tenancy ending: all tenants are leaving
is paid out. the tenancy.