Request for Absence from Property Form

Request for Absence from Property

For more information, please refer to our Absence from Property Policy.

Bridge Housing will advise the outcome of your application in writing.

Full Name *

Address *

Email Address

Contact Number

Please enter at least one contact method

What is the main language you speak at home?

Do you need an interpreter when dealing with Bridge Housing?

YesNo

Absence from Property

How long do you expect to be absent from your property?

Start Date *

End Date

Total Period - in days *

What is the main reason for your absence from your property? *Please provide supporting documents if available

Supporting Documents

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Tenancy Agreements

How will your rent and utilities (water, electricity, gas) be paid while you are absent from your property?

Appointed Agent During Absence

You must make arrangements for the property to be adequately cared for by a responsible adult while you are absent from the property

Please provide the contact details for someone that we can contact in relation to your property during your absence.

Full Name *

Relationship to Main Tenant *

Address

Email Address

Contact Number *

Notice and Declaration

Under the Housing Act 2001, the Privacy and Personal Information Protection Act 1998 and the Health Records and Information Privacy Act 2002, your consent is needed before Bridge Housing can exchange your personal information (including healthinformation) with another party unless require or authorised by law to do so.

Under the Housing Act 2001, a fine up to $2,200 and/or three months imprisonment applies for making a false statement or representation. Bridge Housing may refuse further assistance or prosecute anyone who wilfully makes any false statements as a result of which they obtain accommodation or other financial benefit of any kind.

Please sign and read the declaration below.

• I understand the instructions given on this declaration form.

• To the best of my knowledge, the information provided in this form is correct.

• I understand there are penalties for giving false or misleading information.

Name

Your Signature *

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.