Administered by
AnglicareSA
Level 1, 560 North East Road,
HOLDEN HILL SA 5088
Tel: 08 8118 2600
TENANCY APPLICATION FOR COTTAGE HOME Date….....……
Full Name: Mr/Mrs/Ms/_____________________________________________
Age:___________Yrs Date of Birth:________________
Current Address:__________________________________________________
________________________________________________________________
Telephone Number:________________Other Contact No:_________________
_______________________________________________________________________
Full Name: Mr/Mrs/Ms/_____________________________________________
Age:___________Yrs Date of Birth:________________
Current Address:__________________________________________________
________________________________________________________________
Telephone Number:________________Other Contact No:_________________
Preferred number of bedrooms 1 2 Either is acceptable
Do you have any special needs in your housing? e.g. ramp for wheelchair or walker, room for
storage of Gofer, walk in shower etc.. Yes No
IF YES, PLEASE BRIEFLY DESCRIBE THESE NEEDS:
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Do you identify yourself as Anglo-Australian? Aboriginal/Torres Strait Islander?
Refugee Other? Please specify …………………………….………
What language is spoken at home? ………….…Do you need a translator? Yes No
If yes, please fill in the following details:
Translators Name: …..………………………………………………..
Translators Phone Number: ………………………………………….
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Details of persons we can contact (Not living with you)
Name:__________________________________Relationship to you_______________
Address_______________________________________________________________
________________________________________Telephone No:__________________
Name:__________________________________Relationship to you_______________
Address_______________________________________________________________
________________________________________Telephone No:__________________
Will you be keeping any pet: Yes / No Type______________ Age ____ Desexed Yes / No
Do you own a vehicle Yes / No __________________
Financial Position
Please complete the following to help us to prioritise our waiting list and understand the
urgency of your application.
Income (per fortnight)
Centrelink Pension $_________ Centrelink Card Number…………………………
Rent Relief $_________ Card Expiry Date………………………………
Veteran Affairs Pension $_________ Gold Card Holder? Yes No
Superannuation $_________
Overseas Pension $_________
Other $_________
Employment $_________
House or Land Value $_________
What is the total value of your assets? $ ……………………………………………….
What is the total of your bank accounts/Investments? $…………………………………
YOUR CURRENT HOUSING
What type of house do you live in? Describe, e.g. 2 br. flat, 3 br. House, etc.
……………………………………………………………..………………………………
Is it: Private Rental
SA Housing Trust
Buying Your Own Home
Own your Own Home
Share House
Other
Do you own your own home? Yes No
If Renting How Much Rent Do You Pay Per Week? $…………
How Long Have You Lived at Your Current Address? Years . . . . Months . . . .
Why do you want to move from your present accommodation?
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e.g. Rent too high, eviction, facilities, house/garden are too small/large, location etc.
Please write all your reasons to help us understand why you wish to move
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How many times have you moved in the past two years? ………………………………..
Have you applied for accommodation from the South Australian Housing Trust? Yes No
Aboriginal Housing Authority? Yes No
If yes, which year did you apply? ……………………
Have you recently lodged a priority housing application Yes No
Have you applied for accommodation from any other housing authority/organization, besides
private rental? Yes No
If yes, to which authority/organization did you apply? …………………………………….…………
Other Information
Do you have any circumstances that you wish to have taken into account?
e.g. health problems, disabilities, diabetes, social reasons.
Do you have a hearing or sight impairment, Do you wear a Hearing Aid? Yes No
IF YES, PLEASE BRIEFLY DESCRIBE:
…….…………………….………………………………………………...…………………..….……………
……………………………………….…………………………………………….…………………..………
……….………………………………………………………………………………………………...
A doctors letter, and/or a letter from your support worker, where appropriate, should be attached
to this application.
…………………………………………………………………………………………………………………
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Doctors Name:____________________________Telephone No:________________
Address:_____________________________________________________________
Name of Support Agency (where appropriate) ……………………………………
Their phone number: …………………………..
YOUR SUPPORT WORKERS NAME: ………………………………………………………..…..
To help us with our advertising, please tell us where you heard about Laura & Alfred West Homes Inc?
Friend Newspaper Local Council Church Other ____________________________
I/We confirm and acknowledge that:
1. The information contained in this application is true and correct.
2. I am/we are over the age of 50 years and that the rental payments are within my/our means.
3. Only those persons named on the application will reside permanently at the property.
4. I/We will pay 2 weeks rent & a bond of 4 weeks rent before taking possession of the property.
5. I/We agree to pay rent by direct debit from my/our bank account or Centrepay.
Signature of Applicant: ______________________________Date: _________________
Signature of Applicant: ______________________________Date: _________________
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st nd rd
PREFERRED LOCATIONS: (Subject to availability) Please list in order of preference 1 2 3 .
Please keep in mind that due to the limited number of two bedroom units we manage,
priority is given to couples over singles who wish to apply for a two bedroom unit.
Burnside 8 to 18 Young Street
6 two bedroom units with a separate laundry as part of each unit.
Campbelltown 4 Gorge Road (Corner Lower North East Road & Gorge Road)
26 Two bedroom units with laundry facilities and built in robes.
Elizabeth East 30 Fletcher Road, (Corner of Fletcher Road & Atlanta Street)
16 One bedroom units with washing machine facilities in the bathroom.
Elizabeth North 18 Knighton Road.
8 two bedroom units with a separate laundry as part of each unit.
Elizabeth North 121 Woodford Road.
16 two bedroom units with carport and private rear yard
Elizabeth South Cnr Goodman & Blake Roads
14 two bedroom units with carport
Gilles Plains 1 Mary Avenue & 8 Anita Avenue, Gilles Plains
6 two bedroom units with a separate laundry as part of each unit.
Kilburn 35 Brooklyn Street (Corner of Brooklyn Terrace & Le Hunt Street)
6 One bedroom units with washing machine facilities in the bathroom.
Mansfield Park 28 Hampshire Street (Cnr of Hampshire, Kimberley & Beaconsfield Roads)
14 One bedroom units with 6 Communal Laundries equipped with automatic washing machines.
Mitchell Park 29 Richard Avenue
8 One bedroom units with washing machine facilities in the bathroom.
Mitchell Park 34 Daisy Avenue
16 One bedroom units with washing machine facilities in the bathroom.
Northfield 1 Firth Avenue
11 Two bedroom units with laundry facilities and built in robes.
Seaford Rise 8 Osprey Avenue
5 One bedroom units and 3 Two bedroom units all with laundry facilities in the bathroom.
Woodville Gardens Cnr Danvers Grove & Eighth St
23 two bedroom units with laundry facilities, carports and private rear yards
Confidential Page 4 of 4
