Application for Rental Subsidy

The Application for Rental Subsidy confirms to Bridge Housing who lives in your household and any income they might have to assess your eligibility for rental subsidy.

Please ensure you include all household members on the form and include all sources of income for anyone aged 18 years and above, so we can accurately calculate your household's rent.

Address *

Email Address

Mobile

Home Phone

Please enter at least one contact method

Head Tenant

The head tenant is the person who signed your lease and appears on your rent account statement

Date of Birth *

Gender *

Relationship to You

Date This Person Moved Inonly fill if person has moved into the property in the past 6 months

Source of Income *

Centrelink Pension and BenefitsWages SuperannuationBusiness Income Compensation Cash/Investments/Savings Department of Veterans' Affairs Payment Foreign PensionForeign Income Trust and CompaniesOther - please advise below

Household Member 1

Date of Birth

Gender

Relationship to You

Date This Person Moved Inonly fill if person has moved into the property in the past 6 months

Source of Income

Centrelink Pension and BenefitsWages SuperannuationBusiness Income Compensation Cash/Investments/Savings Department of Veterans' Affairs Payment Foreign PensionForeign Income Trust and CompaniesOther - please advise below

Household Member 2

Date of Birth

Gender

Relationship to You

Date This Person Moved Inonly fill if person has moved into the property in the past 6 months

Source of Income

Centrelink Pension and BenefitsWages SuperannuationBusiness Income Compensation Cash/Investments/Savings Department of Veterans' Affairs Payment Foreign PensionForeign Income Trust and CompaniesOther - please advise below

Household Member 3

Date of Birth

Gender

Relationship to You

Date This Person Moved Inonly fill if person has moved into the property in the past 6 months

Source of Income

Centrelink Pension and BenefitsWages SuperannuationBusiness Income Compensation Cash/Investments/Savings Department of Veterans' Affairs Payment Foreign PensionForeign Income Trust and CompaniesOther - please advise below

Household Member 4

Date of Birth

Gender

Relationship to You

Date This Person Moved Inonly fill if person has moved into the property in the past 6 months

Source of Income

Centrelink Pension and BenefitsWages SuperannuationBusiness Income Compensation Cash/Investments/Savings Department of Veterans' Affairs Payment Foreign PensionForeign Income Trust and CompaniesOther - please advise below

Household Member 5

Date of Birth

Gender

Relationship to You

Date This Person Moved Inonly fill if person has moved into the property in the past 6 months

Source of Income

Centrelink Pension and BenefitsWages SuperannuationBusiness Income Compensation Cash/Investments/Savings Department of Veterans' Affairs Payment Foreign PensionForeign Income Trust and CompaniesOther - please advise below

Support Documents

All relevant documentation as proof of income for each household member.

Browse

e.g. Centrelink Income Statement, Payslips, Statutory Declaration, Bank Statements

Source of Income	Documentation for Income Earned
Centrelink Pensions and Benefits	Current itemised Centrelink Income Statement, unless you have given consent for us to get this information directly from Centrelink
Department of Veterans' Affairs Payment	Current itemised statement from the Department of Veterans’ Affairs
Salary or Wages	4 weeks of payslips for fixed-hour workers or 12 weeks of payslips for varying hours and casual workers
Self Employed	Current profit and loss statement or copy of latest tax return
Superannuation	Current letter from the superannuation fund confirming the amount received
Overseas Pension	Current letter from the respective government detailing the amount and frequency of payments
Savings/Investments/Shares	Letter/Statement from the financial institution showing interest or dividend earned
Maintenance	Statement from Child Support Agency or Centrelink

Declaration

I understand that in order to have my rent rebated I must provide current income details for all household members.

I understand that if I have been dishonest in any of the income information provided, Bridge Housing can cancel the rental rebate and charge market rent.

To the best of my knowledge the information I am providing is a complete and accurate statement of the people living in my household and the income they and I receive.

Signed: *

Clear

Date Signed *

Bridge Housing's Privacy Policy describes how personal information about you is collected, stored, shared to external parties and discarded in accordance with the NSW Privacy Act 1998.

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