Application for Rentstart Bond Loan

Please make sure you have read Part E of the Rentstart application form which is available from any Homes NSW office, or
community housing provider participating in Housing Pathways, or from the DCJ website at DCJ.nsw.gov.au/housing.
Send your completed application to email: rentstart@homes.nsw.gov.au
Your application must include details of all people to be housed, including children. Each household member 18 years or over MUST
complete an Additional Persons form.
This form should be read with the ‘Private Rental: Documents You Need’ fact sheet. A copy of this is available from the DCJ website
DCJ.nsw.gov.au/housing

Please provide all the information listed below for yourself and each person 18 years or over in your household.

Two forms of identification (e.g. driver’s licence, passport OR confirmation of identification signed by your real estate agent
or a government employee)

Statements for your bank accounts for the last four weeks (displaying history of transactions or savings bank passbook)

Completed Property Information Form (Part C - to be completed by your real estate agent or landlord)

Proof of income - your income confirmation details MUST be current. You will need to send proof of income with your
application, unless your sole income is from Centrelink. If this is the case, you can sign the Centrelink release of information
section on page 4. Proof of income includes pay slips, they must show Year to Date (YTD) salary figures. If you are unable to
provide the YTD figures, four current payslips need to be shown, or you can have your employer complete an Income from
Employment form (Part D)

Proof of current assets

Passport or current visa (if you are not an Australian Citizen)

(for example: a Notice of Termination from your current agent/landlord, a medical certificate, letter from your support agency )

Note: We will not be able to process an incomplete application.

Checklist: Have you completed (and signed where relevant)

Part A - Application for Rentstart Bond Loan form

Part B - Additional Persons form - if there are additional people aged over 18 years to be housed with you

Part C - Property Information form - to be completed by the real estate agent or property owner

Part D - Income from Employment form or payslips - if you are employed

Part E - Bond Loan Agreement - you must read and understand the Terms and Conditions of the Rentstart Bond
Loan before you apply
Authority for Bond Loan Deduction - if you are in receipt of any form of Centrelink payments, an Authority must be
submitted with your application

Once your completed application is received, we will contact you on the phone number that you have provided in this
application form. If you have provided a mobile number, an SMS will be sent within four hours to advise we have
received your application. If you do not provide complete information, processing your application will be delayed.
Homes NSW will assess your application in one working day (24 hours). If you have not received a response after one
working day (24 hours), please call 1800 422 322.
IF YOU ARE EMAILING THIS FORM, PLEASE DO NOT RETURN THIS PAGE.

Rentstart hours of operation Postal Address

Mon - Fri 8.00am - 6.00pm Housing Contact Centre
Sat 9.00am - 5.00pm Locked Bag 7150
Phone 1800 422 322 Liverpool BC NSW 1871

DCJ3049A 02/24 Page 1 of 5

Part A - Application for Rentstart Bond Loan
1. Details of main applicant Title
1. Details of main applicant
Mr, Mrs, Ms, Miss, Mx
Last name
or family name

Given name(s)

Sex Male Female

Date of birth DD/MM/YYYY

Contact number

Email address

Centrelink Reference Number (if applicable)

Current residential address

Town/Suburb Postcode

2. What is the main language you speak English Other

at home? give details

What language?

3. Do you need an interpreter when Yes No

dealing with Homes NSW? give details
This includes an interpreter for people
with a hearing or speech impairment

4. In what country were you born?

5. What is your current citizenship status? Australian citizen (Australian born or obtained citizenship)

Permanent resident

Sponsored migrant

Refugee status

Asylum seeker with bridging visa

What is your visa
subclass number?
Date of arrival
in Australia? DD/MM/YYYY

6. Are you of Aboriginal or Torres Strait Yes No Go to Q.7

Islander origin? give details

Aboriginal

Torres Strait Islander

Aboriginal and Torres Strait Islander

DCJ3049A 02/24 Page 2 of 5

Part A - Application for Rentstart Bond Loan
7. Have you been homeless within Yes No Go to Q.9
the last five years?

8. How many times have you been (please indicate the number of times
homeless within the last five years? you have been homeless)

9. Are you homeless at the moment? Yes No Go to Q.11

10. How long have you been homeless? Day(s) Month(s)

(please place a number in the box
within appropriate timeframe)
Week(s) Year(s)

11. Do you have somewhere safe to Yes No

stay tonight?

12. Are you at risk of becoming homeless Yes No Go to Q.15

sometime soon? give details

13. Where have you been staying?

(e.g. streets, hostel, backpackers,
friends, refuge, rented home etc.)

14. When will you be leaving the

place where you are staying?

15. Is anyone on this application an

employee of Homes NSW? Yes No

Full name

16. Have you had any previous assistance

from Homes NSW? Yes No

17. What is the total amount of cash,

shares, term deposits, other assets $
held by your household (if any)?

18. Do you have deductions made from Yes No

your household income? give details
(e.g. maintenance, child support)
Deduction type
and amount
Paid
(weekly/fortnightly)

19. Do you or anyone to be housed with Yes No

you own or part own any property?

You need to complete the Details of Land or Property Ownership

form available on the DCJ website DCJ.nsw.gov.au/housing.

DCJ3049A 02/24 Page 3 of 5

Part A - Application for Rentstart Bond Loan
Additional Assistance
Homes NSW will provide a Rentstart Bond Loan for up to 100% of the bond. However, clients are able to apply for less than 100% of
a bond, but not less than 25%. In exceptional circumstances, a small amount of advance rent may be provided. To be eligible, you
must have a significant reason for moving from your current accommodation such as a medical condition or eviction. We also
consider situations where you or a household members personal safety is at risk such as in cases of domestic violence or child abuse
or neglect. You must supply written supporting evidence such as legal documents or a doctor’s letter setting out how you meet the
requirements.
20. Do you wish to apply for additional
assistance? (supporting evidence must Yes No
be supplied)

What is the reason you need to move

from your current accommodation?

Household members under 18 years:

Does this child

Relationship to receive Austudy,
Name Date of Birth Country of Birth
Main Applicant ABStudy or Youth
Allowance? (Y/N)

DD/MM/YYYY
DD/MM/YYYY
DD/MM/YYYY

Income Confirmation Scheme Consent Authority

If you or anyone on this application wish to participate in the Centrelink Income Confirmation Scheme please complete
the consent form below.
This consent will be used for the sole purpose of authorising Centrelink to provide information to the Homes NSW to
assess your eligibility for concessions or services provided by Homes NSW.
If you do not want Centrelink to provide your information electronically to Homes NSW, you will need to obtain the
information required from Centrelink yourself and provide it to Homes NSW.

Please read and sign the consent and the declaration below:
• I authorise Homes NSW to use Centrelink Confirmation eServices to perform a Centrelink enquiry of my Centrelink
Customer details and concession card status in order for Homes NSW to determine if I qualify for a concession,
rebate or service.
• I authorise the Australian Government Department of Services Australia (the Agency) to provide the results of that
enquiry to Homes NSW.
• I understand that the Agency will use information I have provided to Homes NSW to confirm my eligibility for
concessions, rebates or services and will disclose to Homes NSW my personal information including my name,
address, concession card status, payment type, payment status, income, assets, one-off payments, deductions and
shared care arrangements.
• I understand that this consent, once signed, remains valid while I am a customer of Homes NSW unless I withdraw
it by contacting Homes NSW or the Agency.
• I understand that I can obtain proof of my circumstances/details from the Agency and provide it to Homes NSW so
that my eligibility for concessions, rebates or services can be determined.
• I understand that if I withdraw my consent or do not alternatively provide proof of my circumstances/details, I may
not be eligible for the concessions, rebates or services provided by Homes NSW.
Centrelink
Customer
Family name Given name(s) Date of birth Signature Date
Reference
Number

DD/MM/YYYY DD/MM/YYYY
More information about Centrelink Confirmation eServices is available on Centrelink’s website at
www.servicesaustralia.gov.au/cces.
DCJ3049A 02/24 Page 4 of 5
Part A - Application for Rentstart Bond Loan
Consent to Homes NSW
1. Pursuant to Section 71 of the Housing Act 2001 and the Privacy and Personal Information Protection Act 1998, I consent, direct
and authorise Homes NSW to disclose personal information regarding myself for the purpose of processing this application. This
consent shall include disclosure to the Rental Bond Board and any relevant estate agency.
2. I also authorise Homes NSW to collect personal information regarding myself from any third party for the purpose of processing this
application and direct such third party to provide to Homes NSW the information sought. This authority extends to and includes
collection of information from third parties arising from claims for bond at conclusion of the lease.

Declaration by applicant
I certify that the information I have given is true and correct.
a) I understood the instructions given on the form.
b) I declare all the information I have given is true and correct to the best of my knowledge.
c) I am aware the maximum penalty under the Housing Act 2001 for making a false statement or representations is a fine of $2,200.
d) I understand Homes NSW may refuse further assistance or prosecute me if I have made any wilfully false statements as a result
of which I obtain accommodation or financial benefit of any kind.

Please mark to confirm

I have read the Rentstart Bond Loan Terms and Conditions (Part E) Yes No

I have understood the Rentstart Bond Loan Terms and Conditions (Part E) Yes No

I have decided to seek independent expert advice to have the Terms and Conditions (Part E) Yes No
explained to me

Sign here  Date DD/MM/YYYY

Full name (please print)

Declaration from person assisting or completing this application on behalf of the applicant
Please sign below if you have complied with and you understand the following statements:
a) I filled in this form on the basis of the information the applicant gave me.
b) I have read out the form and the answers to the applicant who seemed to understand them.
c) I understand that monetary penalties including imprisonment for a period of up to six months may be imposed by a court if I have
made any wilfully false statement as a result of which I obtain accommodation or financial benefit of any kind.
d) I understand Homes NSW may refuse further assistance or prosecute me if I have made any wilfully false statements as a result
of which I obtain accommodation or financial benefit of any kind.

Please mark to confirm

I have read the Rentstart Bond Loan Terms and Conditions to the applicant (Part E) Yes No

The applicant seemed to understand the Rentstart Bond Loan Terms and Conditions (Part E) Yes No

I have assisted the applicant to seek independent expert advice to have the Terms and Yes No
Conditions (Part E) explained to them

Sign here  Date DD/MM/YYYY

Full name (please print)

Office use only - Documentation sighted and certified (Can be completed by a Homes NSW officer, licensed real-
estate agent or staff from other NSW Government agencies)

Citizenship Type Number

ID Type Number

Name Position

Signature Agency

Date DD/MM/YYYY
Is this a joint or shared Yes No Is this client receiving a Yes No
household? Private Rental Subsidy?
DCJ3049A 02/24 Page 5 of 5