Application

Save this form to your hard drive or desktop before you start filling it in.
This bond loan application is for private renters seeking an interest-free loan from the Department of Health and
Human Services (DHHS) to help cover the cost of a rental bond.

OFFICE USE ONLY

Date received
Received by
Date registered
Bond reference number
Name of bond agency

Evidence Yes or No
Income proof confirmed and attached
ID proof confirmed and attached
Landlord section completed

Applying for a Bond Loan

You will need to complete this application to apply for a bond loan from DHHS.

What is a bond loan?

Private rental is housing that is available in the private market. It covers a range of housing types, including
houses, apartments and caravan parks.
If you want to rent privately in Victoria and can’t afford to pay the bond, you may be able to borrow money for an
interest-free bond loan from DHHS through this scheme.
If you want to rent privately, most landlords will ask you to pay a bond before you move in. A bond is a security
deposit in case you damage the property. The bond money is held by the Residential Tenancies Bond
Authority. It is returned in full at the end of your lease, unless the landlord is eligible to claim for damages or
unpaid rent.
The full bond loan amount must be paid back at the end of your tenancy. Even if your landlord keeps some of the
bond because of damages, you must still repay the full amount of the loan.

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The loan is for bonds only and cannot be used for rent in advance or moving costs. If you need help with these
costs, see if you are eligible for help from the Housing Establishment Fund.

Am I eligible to apply?
To be eligible to apply for a bond loan, you should:
 Be an Australian citizen or permanent resident of Australia
 Meet the income and assets eligibility limits for your household
 Repay any money that you still owe from a previous public housing tenancy or bond loan
 Not rent a property that will cost more than 55 per cent of your gross weekly household income
You can apply as a single person, a couple, family or group of people who want to share a home.

Things to know
• You will need to provide proof of identity, residency status, income and assets, for each person applying
• You may need to provide other documents
• You are also able to apply online through MyGov
• Generally, we cannot issue a bond loan to you if you have already paid the bond to the owner or agent.

More information about privacy

The Department of Health and Human Services is committed to protecting your personal information. We need to
collect and handle your personal information in order to be able to process your application. All the information you
give us will be handled in accordance with the Privacy and Data Protection Act 2014 and the Health Records Act
2001.
If you are using other departmental programs, we may share some of your information with them to help us
coordinate better services to you. We will not use your information for any other purpose other than those listed on
these forms, to provide services to you, or without your consent, unless the law requires us to do so.
Accessing your information
You can access your information through the Freedom of Information Act 1982 or through the Privacy and Data
Protection Act 2014. For information about Freedom of Information requests call 1300 475 170 or apply online at
foi.vic.gov.au.
If you are seeking information from a community housing organisation or designated support provider then you
have access rights under the Privacy and Data Protection Act 2014. For further information about privacy call 1300
884 706 or email [email protected]

Creating a bond loan application

In this section, we will ask for information about you and anyone else who is applying for a bond loan with you. You
may be applying on behalf of other people.
Questions with an (*) must be answered.
Use black or blue pen, and mark boxes with an X.
• Use CAPITAL letters
• Attach all the documents we ask for
• Have all applicants sign the declaration
• Ask the real estate agent or landlord to fill in Sections C and E (if applicable)
• Fill in the checklist on the back page of this application
• Take or send your application to your local DHHS office (or bond agent if you live in a rural area).

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DHHS local offices are listed in the government section of the White Pages directory under Department of Health
and Human Services (Vic). You can also find locations of DHHS offices on the DHHS website
<https://dhhs.vic.gov.au/locations-dhhs-offices-victoria>.

Generally, applications take up to three working days to assess. Your local office can tell you how long it will take to
make a decision about your application.
If your application is approved, a bond loan voucher made payable to the Residential Tenancies Bond Authority will
be given to you or sent directly to your landlord or their agent.
The bond loan voucher acts as payment and lodgment form. The landlord will use the bond loan voucher to lodge
the bond with the Residential Tenancies Bond Authority.
For further information, please ask for a copy of the department's bond loan brochure or fact sheet or visit the
Housing.vic website <http://www.housing.vic.gov.au/>

Documents we need for this application

What follows is a list of documents that you and everyone who will live with you may need to give us to confirm
your general eligibility for a bond loan.
As you fill in the form, you will see a symbol of a piece of paper with a paperclip:

It is there to tell you what other documents you may need to give us in some situations.

General eligibility
For each person who will live with you, you will need to give us:
 Proof of Australian Residency (if applicable) for each person applying
 Proof of income and/or assets for each person applying
 Proof of identity for each person applying

Proof of Australian residency

You may need to provide the following documentation when completing this application
for each person who was not born in Australia, please include one of the following:
 Australian citizenship certificate
 Immigration visa
 passport or a letter from the Department of Immigration and Border Protection.

Proof of income
As a general rule, if you:
 receive a Centrelink payment and you agree to use Centrelink Confirmation eServices (see Section I) – you do
not need to give us any income or asset related documents
 receive a Centrelink payment and you do not agree to use Centrelink Confirmation eServices – you will need to
give us an income statement from Centrelink that is less than two weeks old
 receive an income from the Department of Veterans’ Affairs (DVA) – you will need to give us an income and
asset statement from DVA that is less than two weeks old
 have a paying job – you will need to give us a payslip or a wage statement signed by your employer. It needs to
show your wages before tax for the past 13 weeks
 are self-employed – please have an accountant complete a self-employed 13-week profit and loss statement.

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Proof of assets
If bank accounts are your only asset, you need to provide a current copy of your bank book or bank statement (less
than two weeks old) showing your name. An automatic teller machine (ATM) statement is allowed as long as it
shows that you are the card holder.

Proof of identity
To apply for a bond loan you are required to provide 100 points of identification . The department accepts original
documents or certified copies. A full list of identification documents can be found on the departments housing
website < http://housing.vic.gov.au/proof-identity> or contact your local housing office.

Confirmation of children’s names and custody arrangements

If there are dependants in the household, you will need to give us one of the following documents to confirm the
names of the children:
 Medicare card or Health care card.
 If you are requesting additional rooms for child access arrangements, documentation from a solicitor, the Family
Law Court, or a statutory declaration from the primary caregiver to confirm the custody arrangements.

Need more information?

Visit the RentAssist page on the HousingVic website <http://www.housing.vic.gov.au/>
Contact your local Department of Health and Human Services office. You can find locations of DHHS offices on the
DHHS website <https://dhhs.vic.gov.au/locations-dhhs-offices-victoria>.

Bond details
Bond Loan Details
In this section, we will ask for information about you and anyone else who is applying for a bond loan with you. You
may apply on behalf of other people.

Questions with an (*) must be answered

How many people are
on your lease?*
This refers to the number of people on your lease, not the number of people applying for this bond loan.

Collection of your bond loan*

If you are approved for this bond loan, you will need to collect a voucher from a DHHS Housing Office.

Please enter the

office you wish to
collect your bond
loan from

Section A – Primary applicant

Applicant details
In this section we will ask for information about you. Questions with an (*) must be answered

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A1 Title
Title Mark with X Title Mark with X
Mr Dr
Miss Prof
Ms Other
Mrs

A2 Your name (as it appears on official documents)

First name

Middle name

Family name

Previous name (if any)

(For example, name at birth,
maiden name, previous
married name, alias)

Preferred name

Proof of identity documents. See ‘Proof of identity’ on page 4 for further information.

A3 Date of birth
Date of birth

A4 Gender
Gender Mark with X
Male
Female
Indeterminate
Intersex
Other

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A5 Marital status
Status Mark with X
Single
Partnere
d
Married

A6 Country of birth
Country

A7 What is your residency status?

Status Mark with X
Australian citizen – Go to A11

Permanent resident

New Zealand resident

Sponsored migrant

Permanent protection visa

Resolution of status visa

Visa subclass (if applicable)

Visa subclass number

A8 When did you start living in Australia?

Date

A9 Are you affected by Centrelink’s two-year newly-arrived residents waiting period?

Option Mark with X
No
Yes

If yes, tell us the expiry date

A10 Did you migrate to Australia under an Assurance of support?

Option Mark with X
No
Yes

If yes, tell us the expiry date

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A11 Aboriginal or Torres Strait Islander
Response Mark with X
No
Aboriginal
Torres Strait
Islander
Both

A12 Do you have any dependent children?

Option Mark
with X
Number of
Yes dependants
No

Contact information

A13 Postal address?

If you don’t have a postal address you can enter the postal address of a friend, relative or support worker.
You may use a ‘care of’ address in situations of family violence or homelessness.

Postal address

PO box

Suburb or town

State

Postcode

A14 What is your residential address?

Same as postal address provided in A13

OR

Residential address

Street number and

name
Suburb or town

State

Postcode

Telephone – landline

Mobile

Email address

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A15 I would prefer to receive notifications about the status of my application by:
Method Mark with X
Phone
Email

A16 Do you require an interpreter when speaking with us?

This includes interpreters for languages other than English, and for people who have a hearing or speech
impairment.

Interpreter Mark with X

?
No
Yes

If yes, tell us your preferred language and written language:

Preferred language
Preferred written language

Income and Assets

Please select the income types you are receiving
Option Mark with X
Centrelink Payments
Department of Veterans’ Affairs (DVA) payments
Self employed
Paying job
None
Other
If other please advise

A17 Please provide your Centrelink Reference Number (CRN) Number

CRN

A18 Do you consent to income confirmation?

Option Mark with X
No Go to A19
Yes Sign the Consent to use CCeS in Section I, and
go to A20

Proof of income documents. See ‘Proof of income’ on page 3 for further information.

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Assets
A19 What is an asset?
An asset is something you own that can be turned into money — like shares, businesses, mobile homes and any
cash you have in the bank.
If you are expecting to receive a payout from an organisation like WorkSafe or the Transport Accident Commission
(TAC), please add it here.

Asset type Value Can the asset be

cashed in or sold?
Write ‘Yes’ or ‘No’
$

You will need to attach a document confirming ownership/existence of this asset.. See proof of
assets on page 4 for further information.

A20 Do you own or part-own any real estate?

Option Mark with X
No
Yes

Property address

Suburb or town

State

Postcode

Real estate or Land value $

Are you able to live in the property (mentioned above) permanently?

Option Mark with X
No
Yes
You will need to attach one or more of the following:

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• Letter from approved valuer or solicitor stating the property’s market value and your equity in it.
• If the property is part owned, we need information about your share
• If the property is held in trust, we need a letter from the executor of the estate
Attach a document that details your interest in the property and why you are unable to occupy it

Can this real estate or land be sold? Option Mark with X

Option Mark with X Yes

No
Is the property for sale?
Option Mark with X
No
Yes
You will need to attach a document from the real estate agent confirming this.

If the answer is no to any of the questions above, tell us why

If the property subject to a dispute or an application for settlement in the Family Court?
Option Mark with X
No
Yes
You will need to attach a document from a solicitor confirming this.

Tell us the reason

• If you are unable to live in the property permanently, we need documents that explain why.
• If the property is for sale, we need a document from the real estate agent confirming this.
• If there is a dispute or application for settlement, we need a document from your solicitor including details of
ownership.

A21 Where are you currently living?

Housing Mark with X Housing Mark with X
Caravan park Family and friends
Community care unit Hotel
Crisis accommodation Housing association

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 Housing Mark with X Housing Mark with X
Owner-occupier Temporary accommodation
Private rental Transitional Housing Management
(THM)
Public housing
Vehicle
Rooming or boarding house
Other
Student accommodation

If 'Other, provide details:

Section B – Bond agent

Rural areas only

B1 Is a bond agent assisting with the application?

Bond agents assist applicants living in rural areas who can’t easily get to a DHHS office. Call your local office for
details about your closest bond agent.

Response Mark with X Instructions

No Go to Section C

Yes Go to B2

B2 Bond agent details

Name of bond agent

Postal address

PO box

Suburb or town

State

Postcode

Telephone – landline

Mobile

Email address

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Section C – Real estate agent or landlord
This section can only be completed by your real estate agent or landlord.
The real estate agent or landlord must complete this section so that the Department of Health and Human Services
can make a decision about granting a bond loan. If the landlord is not using a real estate agent, they should also
complete Section E.
If this property is being sub-leased, that is leased from someone with an existing tenancy agreement with a
landlord, contact your local office for information about extra documents that the department requires.

Department of Health and Human Services bond loan — Property details

C1 Names of person or people applying for a bond loan (as it appears on official
documents)

Primary applicant

First given name

Second given name

Family name

Household applicant 2

First given name

Second given name

Family name

Household applicant 3

First given name

Second given name

Family name

C2 This section is being completed by

Person Mark with X Instructions
Real estate agent Do not complete Section E

Private landlord Complete this section and Section E

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C3 Real estate agent or landlord details
RTBA number
Registered name of real estate agent
or landlord
ABN (may not be available for private
landlord)
Postal address
PO box
Suburb or town
State
Postcode
Telephone – landline
Mobile
Email address

C4 Rental property type

Property type Mark Property type Mark
with X with X
Unit House
Flat Rooming or boarding house
Apartment Community managed housing
Caravan Student accommodation

C5 Rental property details

Property address

Suburb or town

State

Postcode

Number of bedrooms

C6 Tenancy lease details

Number of people on lease

Lease start date*

DD/MM/YYYY
Lease end date*
DD/MM/YYYY
Total property bond amount* $

Total weekly rent amount * $

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C7 Real estate agent or landlord’s agreement to the tenancy lease details
Print name of real estate agent or landlord

Signature

(Please sign by hand)

Section D – Bond loan

Your bond loan

D1 Bond amount
How much bond money are you asking for in this bond loan application? $

D2 Has the bond already been paid?

Generally, we cannot issue the bond amount to you if you have already paid it to the owner or agent.

Has the bond been paid already?

If yes, tell us why:

D3 What is your role in the household?

Role Mark with X
Single
Partnered

Partner’s name

D4 What is your share of the rent in the property you want to rent?
Share of rent $

D5 Do you have any dependent children?

Do you have any dependent children?

Number of dependants

Section E – Private landlord release of information

This section is only to be completed by a private landlord who does not use a real estate agent.

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Private owners who do not use a real estate agent may provide the Department of Health and Human Services with
a recent council rates notice or a copy of the property title to confirm ownership of the property.
If you cannot provide either of these documents, complete the Form of authority so that we can confirm ownership
with the local council.
If you do not give permission for the department to obtain this information from the local council, we cannot
consider this bond loan application.

Department of Health and Human Services bond loan — Form of authority

E1 Names of people applying for a bond loan (as it appears on official documents)

Primary applicant

First given name

Second given name

Family name

Household applicant 2

First given name

Second given name

Family name

Household applicant 3

First given name

Second given name

Family name

E2 Property owner details

Name of property owner

Telephone – landline

Mobile

Email address

E3 Local council
Local council name

I authorise the Director of Housing, or officers acting on behalf of the Director of Housing to obtain
information from the local council to confirm ownership of the rental property in E4.

Authorisation given?

E4 Rental property
Property address

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 Suburb or town

State

Postcode

Local council authorisation

The release of the information is requested for the purpose of confirming ownership of a property in order to assess
a Department of Health and Human Services bond loan application and for no other purpose.

I authorise the local council to release information regarding ownership of the rental property to the Director
of Housing.

Authorisation given?

E5 Owner’s signature
Signature

(Please sign by hand)

Date

E6 Office use only – Requesting officer’s signature

Requesting officer’s signature
(for and on behalf of the Director of
Housing as an authorised officer) (Please sign by hand)

Date

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Section F – Other applicants who are applying for a bond loan
About them
This section should be completed for other members of your household who are applying for a bond loan. Do not
include details of dependants here, except where asked.
If there are no other people applying, go to Section G.

F1 About household applicant 2

Applicant details
In this section we will ask for information about other household members applying for bond assistance
Questions with an (*) must be answered

F1.1 Title
Title Mark with X Title Mark with X
Mr Dr
Miss Prof
Ms Other
Mrs

F1.2 Their name (as it appears on official documents)

First name

Middle name

Family name

Previous name (if any)

(For example, name at birth,
maiden name, previous
married name, alias)

Preferred name

Proof of identity documents. See ‘Proof of identity’ on page 4 for further information.

F1.3 Date of birth

Date of birth

Application for RentAssist bond loan 17

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F1.4 Gender
Gender Mark with X
Male
Female
Indeterminate
Intersex
Other

Application for RentAssist bond loan 18

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F1.5 Marital status
Status Mark with X
Single
Partnere
d
Married

F1.6 Country of birth

Country

F1.7 What is their residency status?

Status Mark with X
Australian citizen – Go to
F1.11

Permanent resident

New Zealand resident

Sponsored migrant

Permanent protection visa

Resolution of status visa

Visa subclass (if applicable)

Visa subclass number

F1.8 When did they start living in Australia?

Date

F1.9 Are they affected by Centrelink’s two-year newly-arrived residents waiting period?
Option Mark with X
No
Yes

If yes, tell us the expiry date

F1.10 Did they migrate to Australia under an Assurance of support?

Option Mark with X
No
Yes

If yes, tell us the expiry date

Application for RentAssist bond loan 19

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F1.11 Aboriginal or Torres Strait Islander?
Response Mark with X
No
Aboriginal
Torres Strait
Islander
Both

F1.12 Do they have any dependent children?

Option Mark
with X
Number of
Yes dependants
No

F2 About household applicant 3

Applicant details

F2.1 Title
Title Mark with X Title Mark with X
Mr Dr
Miss Prof
Ms Other
Mrs

F2.2 Their name (as it appears on official documents)

First given name

Second given name

Family name

Previous name (if any)

(For example, name at birth,
maiden name, previous
married name, alias)

Preferred name

Proof of identity documents. See ‘Proof of identity’ on page 4 for further information.

Application for RentAssist bond loan 20

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F2.3 Date of birth
Date of birth

F2.4 Gender
Gender Mark with X
Male
Female
Indeterminate
Intersex
Other

Application for RentAssist bond loan 21

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F2.5 Marital status
Status Mark with X
Single
Partnere
d
Married

F2.6 Country of birth

Country

F2.7 What is their residency status?

Status Mark with X
Australian citizen – Go to
F2.11

Permanent resident

New Zealand resident

Sponsored migrant

Permanent protection visa

Resolution of status visa

Visa subclass (if applicable)

Visa subclass number

F2.8 When did they start living in Australia?

Date

F2.9 Are they affected by Centrelink’s two-year newly-arrived residents waiting period?
Option Mark with X
No
Yes

If yes, tell us the expiry date

F2.10 Did they migrate to Australia under an Assurance of support?

Option Mark with X
No
Yes

Application for RentAssist bond loan 22

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 If yes, tell us the expiry date

F2.11 Aboriginal or Torres Strait Islander?

Response Mark with X
No
Aboriginal
Torres Strait
Islander
Both

F2.12 Do they have any dependent children?

Option Mark
with X
Number of
Yes dependants
No

F3 Income and Assets of applicant 2

F3.1Please select the income types they are receiving
Option Mark with X
Centrelink Payments
Department of Veterans Affairs’ (DVA) payments
Self employed
Paying job
None
Other
If other please advise

F3.2 Please provide Centrelink Reference Number (CRN) Number

CRN

F3.3 Do they consent to income confirmation?

Option Mark with X
No Go to F3.4
Yes Sign the
Consent to use
CCeS in Section
I, and go to F3.5

Application for RentAssist bond loan 23

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 Proof of income documents. See ‘Proof of income’ on page 4 for further information.

F3.4 Assets
What is an asset?
An asset is something you own that can be turned into money — like shares, businesses, mobile homes and any
cash you have in the bank.
If they are expecting to receive a payout from an organisation like WorkSafe or the Transport Accident Commission
(TAC), please add it here.

Asset type Value Can the asset be

cashed in or sold?
Write ‘Yes’ or ‘No’
$

You will need to attach a document confirming ownership/existence of this asset.. See proof of
assets on page 4 for further information.

F3.5 Do they own or part-own any real estate?

Option Mark with X
No
Yes

Property address

Suburb or town

State

Postcode

Real estate or Land value $

Are they able to live in the property (mentioned above) permanently?

Option Mark with X
No
Yes

Application for RentAssist bond loan 24

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You will need to attach one or more of the following:
• Letter from approved valuer or solicitor stating the property’s market value and your equity in it.
• If the property is part owned, we need information about your share
• If the property is held in trust, we need a letter from the executor of the estate
Attach a document that details your interest in the property and why you are unable to occupy it

Can this real estate or land be sold? Option Mark with X

Option Mark with X Yes

No
Is the property for sale?
Option Mark with X
No
Yes
You will need to attach a document from the real estate agent confirming this

If the answer is no to any of the questions above, tell us why

If the property subject to a dispute or an application for settlement in the Family Court?
Option Mark with X
No
Yes
You will need to attach a document from a solicitor confirming this

Tell us the reason

If they are unable to live in the property permanently, we need documents that explain why.
• If the property is for sale, we need a document from the real estate agent confirming this.
• If there is a dispute or application for settlement, we need a document from your solicitor including details of
ownership.

F3.6 What is their role in the household?

Role Mark with X
Single

Application for RentAssist bond loan 25

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 Role Mark with X
Partnered

Partner’s name

F3.7 What is their share of the rent in the property you want to rent?
Share of rent $

F3.8 Do they have any dependent children who have not already been included on this
form?
Do they have any dependent
children?
Number of dependants

F4 Income and Assets of Household applicant 3

F4.1Please select the income types they are receiving
Option Mark with X
Centrelink Payments
Department of Veterans Affairs (DVA) payments
Self employed
Paying job
None
Other
If other please advise

F4.2 Please provide Centrelink Reference Number (CRN) Number

CRN

F4.3 Do they consent to income confirmation?

Option Mark with X
No Go to F 4.4
Yes Sign the
Consent to use
CCeS in Section
I, and go to F4.5

Proof of income documents. See ‘Proof of income’ on page 3 for further information.
If yes is selected

Application for RentAssist bond loan 26

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F4.4 Assets
What is an asset?
An asset is something you own that can be turned into money — like shares, businesses, mobile homes and any
cash you have in the bank.
If you are expecting to receive a payout from an organisation like WorkSafe or the Transport Accident Commission
(TAC), please add it here.

Asset type Value Can the asset be

cashed in or sold?
Write ‘Yes’ or ‘No’
$

You will need to attach a document confirming ownership/existence of this asset.. See proof of
assets on page 4 for further information.

F4.5 Do they own or part-own any real estate?

Option Mark with X
No
Yes

Property address

Suburb or town

State

Postcode

Real estate or Land value $

Are they able to live in the property (mentioned above) permanently?

Option Mark with X
No
Yes
You will need to attach one or more of the following:
• Letter from approved valuer or solicitor stating the property’s market value and your equity in it.
• If the property is part owned, we need information about your share

Application for RentAssist bond loan 27

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• If the property is held in trust, we need a letter from the executor of the estate
Attach a document that details your interest in the property and why you are unable to occupy it

Can this real estate or land be sold?

Option Mark with X
No
Yes

Application for RentAssist bond loan 28

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 Is the property for sale?
Option Mark with X
No
Yes
You will need to attach a document from the real estate agent confirming this

If the answer is no to any of the questions above, tell us why

If the property subject to a dispute or an application for settlement in the Family Court?
Option Mark with X
No
Yes
You will need to attach a document from a solicitor confirming this

Tell us the reason

• If you are unable to live in the property permanently, we need documents that explain why.
• If the property is for sale, we need a document from the real estate agent confirming this.
• If there is a dispute or application for settlement, we need a document from your solicitor including details of
ownership.

F4.6 What is their role in the household?

Role Mark with X
Single
Partnered

Partner’s name

F4.7 What is their share of the rent in the property you want to rent?
Share of rent $

Application for RentAssist bond loan 29

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F4.8 Do they have any dependent children who have not already been included on this
form?
Do they have any dependent
children?
Number of dependants

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Section G – Current or previous assistance from the
Department of Health and Human Services
Social housing

G1 Does anyone included in this application have a current application on the

Victorian Housing Register?
Response Mark with X Instructions

Yes Go to G2

No Go to G4

G2 Do you wish to change the postal address for the application on the Victorian
Housing Register?
Response Mark with X Instructions

Yes Go to G3

No Go to G4

G3 Current details of the application on the Victorian Housing Register

Names of applicants

Service ID

G4 Has anyone included in this bond application received a bond loan from the
department before?
Response Mark with X Instructions

Yes Go to G5

No Go to Section H

G5 Previous bond loan application

Primary applicant

Full name

Property address

Suburb or town

State

Postcode

When did they apply?

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Has this loan been repaid?

Response Mark with X Instructions

Yes Go to Section H

No Tell us why in the next table

If no, tell us why:

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Section H
Statutory declaration to be signed by all applicants
Before checking the box below, please read the following text:
A person who wilfully provides false information to the Department of Health and Human Services in order to
obtain a bond loan may be liable for penalties under Section 40 of the Housing Act 1983 (VIC). Furthermore, any
person or persons making a false declaration are liable to the penalties of perjury under the Evidence
(Miscellaneous Provisions) Act 1958 (VIC) which may include imprisonment.

Primary applicant
Full name

Of (current address)

Suburb or town

State

Postcode

Household applicant 2
Full name

Of (current address)

Suburb or town

State

Postcode

Household applicant 3
Full name

Of (current address)

Suburb or town

State

Postcode

To the Department of Health and Human Services, 50 Lonsdale Street, Melbourne 3000:
1. I, ACKNOWLEDGE that the bond money paid on my behalf to the estate agent or landlord is a loan advanced
by the Director of Housing to me.
2. I, ACKNOWLEDGE that all applicants are jointly, individually or separately liable for any outstanding bond
loan amount. This means that each applicant and all applicants together are liable for the whole bond debt as
per the original bond loan agreement. If any part of the bond is legally withheld by the estate agent or landlord,
the bond debt is equally divided amongst the household members. Before receiving a further bond loan, I may
be required to sign an agreement to repay the remaining bond loan amount allocated to the other household
members.

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3. I, AUTHORISE the Department of Health and Human Services to issue a voucher payable to the Residential
Tenancies Bond Authority, and undertake to provide this voucher to the estate agent or landlord together with
the covering letter and bond lodgement form given to me by the Department of Health and Human
Services.
4. I, AGREE
 to repay the loan immediately to the Department of Health and Human Services if the bond money is
returned to me during or after my tenancy
 to return to the Department of Health and Human Services the voucher for the bond money if the tenancy of
the rented premises does not proceed, and
• to participate in any legal proceedings for the recovery of the bond money.
5. I, ACKNOWLEDGE that I have understood the instructions and information given in this application.
6. I, DECLARE that to the best of my knowledge, all the information in this application for a bond loan has been
provided, and that the information I have provided is true and correct.

In Victoria and is declared by:

Print full name of Primary applicant

Signature of Primary applicant

(Please sign by hand)

Print full name of Household

applicant 2
Signature of Household applicant 2

(Please sign by hand)

Print full name of Household

applicant 3
Signature of Household applicant 3

(Please sign by hand)

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Witnessed before me
The authorised witness must print their name, address and title under section 107A of the Evidence (Miscellaneous
Provisions) Act 1958 (VIC) (as of 1 January 2010), (previously the Evidence Act 1958 (VIC).
They may include a Justice of the Peace, police officer, court registrar, bank manager, medical practitioner, dentist
or housing services officer.

Full name

Signature

(Please sign by hand)

Address

State

Postcode

Authorised title

Date

At

in Victoria

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Section I – Centrelink Confirmation eServices (CCeS)
If you or any household member 18 years or over wish to use Centrelink Confirmation eServices (CCeS) to tell us
about your income and assets, then please read the following information and sign the consent form.
CCeS is an online service that allows us to obtain information directly from Centrelink.
We recommend that you use CCeS if you are a Centrelink customer as we periodically require up-to-date
information about your income and assets to confirm your eligibility for housing services.
CCeS has strict privacy and security standards. We must have your consent before we can obtain information
about you from Centrelink.
You and your household members can provide consent by signing the Consent to use CCeS and marking the
Income confirmation box with an X.
Once you have signed the consent form and marked ‘Income confirmation’ with an X, we can use CCeS to obtain
information about your income and assets directly from Centrelink. This means you will not need to tell us about
your income or assets (apart from lump sum payments). This will make it easier for you and quicker for us to
assess your eligibility for housing services.
More information about CCeS is available on Centrelink’s website
<https://www.humanservices.gov.au/individuals/services/centrelink/centrelink-confirmation-eservices>.

Consent to use Centrelink Confirmation eServices

I/we authorise the Australian Government Department of Human Services (Centrelink) to provide the Victorian
Department of Health and Human Services (the department) with the results of the enquiries I/we have indicated
below in order to enable the department to determine if I/we qualify for one or more of its housing services.
I/we understand that the information provided by Centrelink to the department may contain the following:
 Income confirmation – personal information such as (but not limited to)
• current or historical details of Centrelink payments received
• dependants
• marital or partnered status
• Centrelink deductions
• income from sources other than Centrelink
• assets.
I/we authorise the department to use Centrelink Confirmation eServices to perform a Centrelink enquiry of my/our
Centrelink income, asset and payment details.
I/we understand this consent, once signed, remains valid while I am/we are a customer/s of the department unless
I/we revoke it by contacting the department or Centrelink.
I/we understand that if I/we withdraw my/our consent or do not alternatively provide proof of my/our circumstances
or details, I/we may not be eligible for the service provided by the department.

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Primary applicant
Full name

Date of birth

Address

Suburb or town

State

Postcode

Centrelink Reference Number (CRN)

Income confirmation (Mark with X)

Signature

(Please sign by hand)

Date

Household applicant 2
Full name

Date of birth

Address

Suburb or town

State

Postcode

Centrelink Reference Number (CRN)

Income confirmation (Mark with X)

Signature

(Please sign by hand)

Date

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Household applicant 3
Full name

Date of birth

Address

Suburb or town

State

Postcode

Centrelink Reference Number (CRN)

Income confirmation (Mark with X)

Signature

(Please sign by hand)

Date

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Checklist
Please read through this checklist to make sure that you have fully completed the form and included everything we
have asked for. Mark each completed item with an X.
All documents must be dated no more than 14 days prior to the date on which you submit the application.

Item Description Mark

with X
Section A Completed the primary applicant details in Section A, and provided proof
Primary applicant of identity and residency status if you are not born in Australia.

Section A: CCeS Completed the consent form in Section I if you wish to use Centrelink
Confirmation eServices.
Section A: Income Provided details of your income and assets and the documents the
and assets department asks for.
Section B Asked the bond agent, and they have completed Section B if you are
Bond agent using a bond agent (rural applicants only).

Section C Asked your real estate agent or landlord, and they have completed
Real estate agent or Section C.
landlord
Section D Completed Section D to tell us about the bond loan you are applying for.
Your bond loan
Section E Asked your landlord, and they have provided a copy of a recent rates
Private landlord notice or the property title to confirm their ownership of the property, if
your landlord does not use a real estate agent. Alternatively, they have
completed the Form of Authority in Section E.
Section F Completed details about other members of your household who are
Other applicants applying for this bond loan in Section F. (Do not include details of
dependants here, except where asked.)
Section F: ID and Provided their proof of identity and residency status if they are not born in
residency Australia.
Section F: CCeS Asked them, and they have completed the consent form in Section I if they
wish to use Centrelink Confirmation eServices.
Section F: Income Provided details of their income and assets and the documents we ask
and assets for.
Section G Completed Section G about current or previous assistance that you or
Current or previous anyone else included in this application have received from the
assistance Department of Health and Human Services.

Section H And all the other people applying for this bond loan, have signed the
Statutory declaration declaration in Section H.

Section H: Witness Had the declaration signed before an authorised witness, and the
authorised witness has provided their name, address, title and signature.
Section I Completed and signed the consent form in Section I, and so have all the
Centrelink applicants who want to use Centrelink Confirmation eServices.
Confirmation
eServices

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More information
To find out about housing options, visit the Housing.vic website <http://www.housing.vic.gov.au> or contact your
local housing office online <http://www.housing.vic.gov.au/contact-a-housing-office>.

To receive this publication in an accessible format email Housing Practice and Complex
Support <[email protected]>.
Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne.
© State of Victoria, Department of Health and Human Services, February 2018.
Available on Housing.vic’s Apply for a bond loan page <http://www.housing.vic.gov.au/apply-bond-loan>.

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Language Link
This publication is about housing. If you have difficulty reading English, you can get help with this publication.
Please contact your local office or call Language Link on (03) 9328 0799 for an interpreter.

For other languages, an interpreter is available through your local office.

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