Residential Tenancy Agreement Page 9
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12Tenancy
INSULATION STATEMENT
Landlords must either complete this form or attach an insulation statement containing the same information.
A. THIS SECTION MUST BE COMPLETED BY LANDLORDS OF INCOME-RELATED RENT TENANCIES
1. Does insulation meet the minimum requirements for ceiling insulation?
1
Yes
No
If no, explain what exception applies and which room(s) it applies to (e.g. professional installer cannot access skillion
ceiling above bedroom 2.) If an exception does not apply, explain how you will comply with insulation requirements
within 90 days after the tenancy starts.
2. Does insulation meet the minimum requirements for underfloor insulation?
Yes
No
If no, explain what exception applies and which room(s) it applies to (e.g. professional installer cannot access skillion
ceiling above bedroom 2.) If an exception does not apply, explain how you will comply with insulation requirements
within 90 days after the tenancy starts.
B. THIS SECTION MUST BE COMPLETED BY ALL LANDLORDS
Ceiling insulation
Location/coverage
Complete (all rooms)
Partial (specify areas not insulated):
None
I don’t know as ceiling space is not accessible in the following areas (specify):
Type
Segments/Blankets
Loose-fill
Other (specify)
Ceiling space is not accessible
Bulk Insulation value (R-value):
or minimum thickness:
Age of ceiling insulation (if known):
Condition
Insulation is in at least a reasonable condition (if not, please explain why):
Insulation has no gaps other than clearances where required (e.g. around older style downlights and
chimney flues)
Ceiling space is not accessible
Underfloor insulation
The Building Act 2004 bans the installation
Location/coverage
Complete (all rooms)
and/or repair of foil insulation in residential
Partial (specify areas not insulated):
buildings with existing electrical installations.
It is an offence to breach this ban and anyone
doing so may be liable to a fine of up to
None
$200,000. If your property currently has foil
insulation that is in reasonable condition,
I don’t know as underfloor space is not accessible
then it does not need to be replaced. However
in the following areas (specify):
if your existing foil installation is damaged
(e.g. torn, foil hanging down off the floor
Type
Segments/Blankets
joists), then it must be replaced with an
alternative insulation product that meets
Polystyrene
legal requirements.
Foil
Bulk Insulation with foil lining
Other (specify)
1 For guidance on exceptions and requirements, refer to MBIE’s Insulation Requirements – A Guide for Landlords:
Insulation-requirements.pdf
RTA01 Residential Tenancy Agreement
LANDLORD’S COPY = TOP COPY TENANT’S COPY = BOTTOM COPY
PAGE 9
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