Last name or family name
Given name(s)
Tenancy Address
Phone number
Mobile number
This section is to be completed by the Tenant. Please include the details of each new additional occupant to be housed
with you. Attach proof of identity for each additional occupant in your household. You will also need to attach proof of
citizenship, residency or visa category, property ownership, income and assets for each additional person 18 years old or
over. See the Evidence Requirements Information Sheet for more information.
How many new additional occupants do you want to add?
1 2 3 4 5
Person 1
Full name
Date of Birth
Relationship to you
Customer Reference Number (CRN)
Date when moving into property
Country of Birth
Country of Birth
Main language spoken at home
Non Australian citizen If the additional occupant is not an Australian citizen, what is its residency status and their visa subclass number?
Residency status
Visa subclass number
Date of arrival
Additional occupant’s current housing situation
What date did they move in?
What is the current address?
Additional occupant’s housing history
T-file number or Client reference number
Aboriginal or Torres Strait Islander Origin
Disability/ongoing medical condition
Disability or medical condition
Support arrangements
Name of organisation or program providing support
Name of support worker or person/ individual
Contact phone number
Person 2
Full name
Date of Birth
Relationship to you
Customer Reference Number (CRN)
Date when moving into property
Country of Birth
Country of Birth
Main language spoken at home
Non Australian citizen If the additional occupant is not an Australian citizen, what is its residency status and their visa subclass number?
Residency status
Visa subclass number
Date of arrival
Additional occupant’s current housing situation
What date did they move in?
What is the current address?
Additional occupant’s housing history
T-file number or Client reference number
Aboriginal or Torres Strait Islander Origin
Disability/ongoing medical condition
Disability or medical condition
Support arrangements
Name of organisation or program providing support
Name of support worker or person/ individual
Contact phone number
Person 3
Full name
Date of Birth
Relationship to you
Customer Reference Number (CRN)
Date when moving into property
Country of Birth
Country of Birth
Main language spoken at home
Non Australian citizen If the additional occupant is not an Australian citizen, what is its residency status and their visa subclass number?
Residency status
Visa subclass number
Date of arrival
Additional occupant’s current housing situation
What date did they move in?
What is the current address?
Additional occupant’s housing history
T-file number or Client reference number
Aboriginal or Torres Strait Islander Origin
Disability/ongoing medical condition
Disability or medical condition
Support arrangements
Name of organisation or program providing support
Name of support worker or person/ individual
Contact phone number
Person 4
Full name
Date of Birth
Relationship to you
Customer Reference Number (CRN)
Date when moving into property
Country of Birth
Country of Birth
Main language spoken at home
Non Australian citizen If the additional occupant is not an Australian citizen, what is its residency status and their visa subclass number?
Residency status
Visa subclass number
Date of arrival
Additional occupant’s current housing situation
What date did they move in?
What is the current address?
Additional occupant’s housing history
T-file number or Client reference number
Aboriginal or Torres Strait Islander Origin
Disability/ongoing medical condition
Disability or medical condition
Support arrangements
Name of organisation or program providing support
Name of support worker or person/ individual
Contact phone number
Person 5
Full name
Date of Birth
Relationship to you
Customer Reference Number (CRN)
Date when moving into property
Country of Birth
Country of Birth
Main language spoken at home
Non Australian citizen If the additional occupant is not an Australian citizen, what is its residency status and their visa subclass number?
Residency status
Visa subclass number
Date of arrival
Additional occupant’s current housing situation
What date did they move in?
What is the current address?
Additional occupant’s housing history
T-file number or Client reference number
Aboriginal or Torres Strait Islander Origin
Disability/ongoing medical condition
Disability or medical condition
Support arrangements
Name of organisation or program providing support
Name of support worker or person/ individual
Contact phone number
To complete this form you will need to click on "Send" button and it will generate a PDF, next step is to print that file, sign it and send it to Wentworth.
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