Housing Application Form Page 4
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8Part B – Income and assets details
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Household income details
Please provide evidence of the gross weekly income (before tax) for all household members aged 18
years and over. Attach documents to confirm income received over the past three months as follows:
Wages: payslips for thirteen (13) consecutive weeks or a letter from your employer confirming gross (before
tax) income.
Government pension, benefit or allowance (including Family Tax Benefit Part A): a statement no more
than two weeks old, showing pension, benefit, allowance received from Centrelink, Veterans Affairs or other
agencies.
Self-employed: provide previous financial year’s tax notice of assessment from the Australian Taxation Office.
Please discuss this with a Territory Housing Officer if your business has been operating for less than 12 months.
Income from any other source (e.g. Workers Compensation): a letter or statement of other documentation
that confirms both the source of income and the gross (before tax) amount.
Note: if you are claiming child maintenance payments as exempt income you will need to provide proof of
your payments (such as pay slips, confirmation from the Child Support Agency, or Statutory Declarations
from both parties).
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Statement of assets
Please provide a statement of assets of all household members aged 18 years and over. Attach
documentary evidence of those assets and any loans against them. If any of these assets cannot be
accessed (such as superannuation) you will need to provide supporting documentary evidence.
Normal household goods (furniture, white goods, TV etc.), personal items (clothing etc.) and one family
vehicle are not counted as assessable assets. Assessable assets include high priced saleable items,
financial investments and cash savings.
All bank accounts
Account holder’s name
Bank and branch
Account number
Amount ($)
Fixed term deposits
Account holder’s name
Bank and branch
Account number
Amount ($)
Shares investments (include accessible superannuation funds)
Account holder’s name
Name of shares/funds
Current value ($)
Motor vehicle
Owner’s name
Make and model
Estimated current value ($)
Amount owed ($)
Property and land / mobile home / boat / caravan / any other valuable saleable items
Owner’s name
Description of assets
Estimated current value ($)
Amount owed ($)
If you require additional space, please write on another piece of paper and attach to this form.
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Parent category: Business