Bond Refund Form - Consumer And Business Services - Government Of South Australia
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1
2Consumer and Business Services
Customer Service Centre, 91Grenfell Street, ADELAIDE SA 5000
GPO Box 965, ADELAIDE SA 5001
Telephone: 131 882
Office hours: 9 am - 5 pm
BOND NUMBER
Refunds available between 9 am and 4.30 pm; Mon - Fri
BOND REFUND FORM
How many bond receipts have been issued for
this tenancy? (insert number)
Date tenancy ended:
/
/
PLEASE COMPLETE FORM IN CLEAR PRINT USING BLUE OR BLACK PEN
Address of rental premises (USE BLOCK LETTERS)
Postcode
Amount to be paid to
SIGNATURE of tenant/resident
Name of tenant/resident 1:
Daytime phone no:
tenant/resident 1
Residential tenancy? Ask the landlord/agent if bond is
Do not sign a blank form
Forwarding address
$*
lodged online. If so, tenants must attach proof of ID
Name of Australian bank/building society/credit union
Name of account holder
Complete ALL account details for EFT payment and don't forget your signature
BSB no
-
Account no
/
/
Date
Name of tenant/resident 2:
Daytime contact no:
Amount to be paid to
SIGNATURE of tenant/resident
tenant/resident 2
Do not sign a blank form
Forwarding address
$*
Name of Australian bank/building society/credit union
Name of account holder
BSB no
-
Account no
/
/
Date
Name of tenant/resident 3:
Daytime contact no:
Amount to be paid to
SIGNATURE of tenant/resident
tenant/resident 3
Do not sign a blank form
Forwarding address
$*
Name of Australian bank/building society/credit union
Name of account holder
BSB no
-
Account no
/
/
Date
Amount to be paid to HOUSING SA
$*
Name of landlord/agent/proprietor:
Daytime contact no:
Amount to be paid to
SIGNATURE of
landlord/agent
landlord/agent/proprietor
/proprietor
Forwarding address
Do not sign a blank form
$*
Name of Australian bank/building society/credit union
Name of account holder
BSB no
-
Account no
/
/
Date
Total bond
(* Add together all the $ amounts listed and insert the total here.
$
)
This amount must equal the total amount of bond held by Consumer and Business Services
NB.
• The name and signatures above must match those on the documentation currently held by this office.
• The bank account details must match the parties of the bond. We cannot pay moneys into a third party account.
• If the EFT details do not match, or are incomplete, the EFT will be rejected and a cheque will be drawn.
By completing the above EFT details you are:
• Authorising Consumer and Business Services to use the listed number to transfer moneys owing to you into your account listed above.
• Guaranteeing that the information provided above is correct, and agreeing to indemnify Consumer and Business Services against any
loss or damage suffered if the details provided are incorrect.
PLEASE ENSURE YOU READ THE REVERSE INFORMATION PRIOR TO COMPLETING THIS FORM
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