Housing Application Form Page 2
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Complete Housing Application Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
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8Contact details
Home phone:
Work phone:
....................................................................................
...............................................................................
Mobile phone:
Email address:
..................................................................................
..............................................................................
Residential address
Address:
Postcode:
..................................................................................................................................................................
..................................
Postal address (if different from residential address, or if you expect to leave your current address)
Address:
Postcode:
..................................................................................................................................................................
..................................
Additional contact information:
.......................................................................................................................................................................
..............................................................................................................................................................................................................................................
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Next of kin
In case we are unable to contact you, please supply details for a person who could help us reach you.
Full name:
Relationship to you:
.................................................................................................................
........................................................
Address:
Postcode:
..................................................................................................................................................................
.................................
Home phone:
Work phone:
....................................................................................
...................................................................................
Mobile phone:
Email address:
..................................................................................
..............................................................................
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Previous accommodation
Have you, or any other person named in this application, previously been a public housing tenant in the
Northern Territory?
Yes
No
If yes, when?
...................................................................................................................................................................................................................
Where did you/they live?
.........................................................................................................................................................................................
Why did you/they leave?
..........................................................................................................................................................................................
Please list the accommodation you have lived in during the past 12 months.
Dates
Address
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Household member details
Have you, or any person to be housed with you, been known by another name(s) in the past?
(e.g. name changed by deed poll, marriage or divorce)
Yes
No
If yes, please list the name of each person and their past names:
....................................................................................................
..............................................................................................................................................................................................................................................
You will need to provide suitable identification for every household member as well as evidence of your
household structure. For example:
• Marriage certificate, statutory declaration of de facto relationship
• Birth certificate, custody papers or proof of receipt of Family Tax Benefit payment for custody of children
and/or dependants.
Please refer to Section 12 for further examples of supporting documentation.
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Parent category: Business