New Zealand Residential Tenancy Agreement Form Page 3
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84. Insert other terms of this tenancy (eg. pets, number of tenants, reimbursement of recovery costs,
right of renewal if tenancy is a fixed-term)
If necessary, please continue on a separate sheet and attach it to this agreement and ensure that all parties have signed and dated it.
LANDLORD’S STATEMENT ABOUT INSULATION
The tenancy agreement must contain a signed statement from the landlord that details information about the location, type
and condition of all insulation in the premises and other matters. For more information about insulation requirements in the
Residential Tenancies (Smoke Alarms and Insulation) Regulations 2016, please see final page.
1. Has any insulation been installed in the ceilings, floors or walls of the premises:
Yes
(Please complete section 2)
No
(Please fill in the below if you are the landlord of an income-related rent tenancy)
The landlord of an income related rent tenancy must explain in the space below how they intend to comply with
insulation requirements by the 90th day after the commencement of the tenancy, or explain the circumstances giving
rise to an exemption.
2. Please describe on the following page the extent and location of insulation, product type and condition of the insulation
below. Please provide documentary evidence and attach to this agreement if necessary. It is recommended that the
landlord also show the tenant the locations of insulation in addition to this written statement.
Location of insulation:
Floor
Ceilings
Walls
(Please tick all that apply)
Your statement about insulation should include:
›
Where the insulation is, its type (and R rating if known) and condition.
›
If you have been unable to obtain information about insulation in a particular location, an outline of what you have not
been able to obtain and why, and confirmation that you have made all reasonable efforts to obtain the information.
›
This includes if you have been unable to determine all of this information.
›
Landlords of income-related rent tenancies that have existing insulation that does not meet requirements, must
explain in the space below how they intend to comply with insulation requirements by the 90th day after the
commencement of the tenancy, or explain the circumstances giving rise to an exemption.
RTA01 Residential Tenancy Agreement
PAGE 3
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