Bond Lodgement Form
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1
2Bond lodgement form
1. Fill out this form to lodge your bond. The bond money and this form must be sent to the Department of Building
and Housing within 23 working days of the tenant paying it to the landlord. We only accept payments by cheque.
2. Please read the important information on the back of this form before entering any details.
3. ALL sections of this form must be completed.
4. If you have a separate tenancy agreement for a room in the property, please supply the room number.
5. Use black / dark blue pen.
PLEASE NOTE: Incomplete forms will be returned
1
If payment is to an existing bond for this tenancy, enter the bond number here:
2
Address of the rented property
Property ID:
Room
Unit/
Street
Street
no.
Flat no.
no.
name
Town/
Suburb
City
Property/
Rural
Building name
delivery no.
Date tenancy started:
Weekly rent: $
Payment enclosed: $
CHEQUES ONLY
Is this
Boarding
House/
Bedsit/
No. of
Total expected bond
Room
Apt
$
bond for a:
House Room
Townhouse
Flat
bedrooms
for this tenancy:
3
Landlord details
Print your full name(s) below
Are you a first-time landlord? Yes
No
DBH Landlord ID Number
Address for Service (An Address for Service is explained on the back of this form.)
Street
Rural
Street no.
Unit/Flat no.
name
delivery no.
Town/
Suburb
City
Property/
Postcode
Building name
PO Box/
(
)
(
)
Fax
Daytime phone no.
Private Bag
Mobile
Email
4
Tenant details
Are you a first-time tenant? Yes
No
Print your full name(s) below
Address for Service (An Address for Service is explained on the back of this form.)
Street
Rural
Street no.
Unit/Flat no.
delivery no.
name
Town/
Suburb
City
Property/
Postcode
Building name
PO Box/
(
)
(
)
Fax
Daytime phone no.
Private Bag
Mobile
Email
5
Signatures
All landlords and all tenants must sign below to agree that the information provided on this form is true and correct.
Landlord(s) signatures:
Tenant(s) signatures:
Date:
Date:
These signatures must be on the form in order to reduce delays at time of refund.
Please send this form and cheque to the Department of Building and Housing,
PO Box 50 445, Porirua 5240
Please make the cheque payable to: Department of Building and Housing.
* L O D G P P *
If you need help, call freephone 0800 737 666 or visit our website at
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