Tenant Income Asset Application Form Page 2
ADVERTISEMENT
1
2Income Statement
Fortnightly
Gross Amount
Tick for
Amount
Proof
Provided
Child support/Maintenance
Maternity Leave/Allowance
Age Pension
Senior Supplement
Carer Payment
Disability Support Pension
Youth Disability Support Pension
Pension Supplement Basic Amount
Sickness Allowance
Special Benefits
Bereavement Allowance
Wife Pension
Widow B Pension
Double Orphan Pension
Assistance for Isolated Children Scheme
Mobility Allowance
Reportable Fringe Benefits
Reportable Superannuation Contributions
Other Sources of Income
I also confirm that my net assets do not exceed the Queensland Government Department of Housing requirements, nor
own or part own any real estate in Australia or overseas as at the date of this application. The household’s combined
assets need to be disclosed and proof of value need to be provided e.g copies of bank statements, shares, etc).
Household Assets
Amount
Tick for Proof Provided
Overseas Pension
Compensation Payouts or lump sum payouts
Shares
Dividends
Bonds
Debentures
Term Deposits
Property Trusts
Other Trusts or managed Investments inc. Friendly Society Bonds
Caravan/Mobile Home/live-abroad boat
Residential Real Estate
Vacant Land
Industrial and/or Commercial Property
Other
If you have received any superannuation payments in the form of a lump sum or an allocated pension provide details.
Superannuation Yes/No
I confirm that the information provided is true and correct.
Tenant signature
Tenant signature
Date:
Date:
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal