Application to be absent from a Dwelling

This form is to be completed by a tenant to apply to Wentworth Community Housing for approval to be absent from a dwelling. For information or assistance with this form, contact your local office on 02 4777 8000.

Tenant Information

Title

Last name or family name

Given name(s)

Date of Birth

Tenancy Address

Phone

Mobile

Current Household Members

Please include the details of each household member currently residing at the property and state whether they will stay at the property during your absence.

How many household members are currently residing at the property?

Person 1

Full Name

Title

Sex

Date of Birth

Relationship to you

Customer Reference Number (CRN)

Will this person stay during your absence?

Person 2

Full Name

Title

Sex

Date of Birth

Relationship to you

Customer Reference Number (CRN)

Will this person stay during your absence?

Person 3

Full Name

Title

Sex

Date of Birth

Relationship to you

Customer Reference Number (CRN)

Will this person stay during your absence?

Person 4

Full Name

Title

Sex

Date of Birth

Relationship to you

Customer Reference Number (CRN)

Will this person stay during your absence?

Person 5

Full Name

Title

Sex

Date of Birth

Relationship to you

Customer Reference Number (CRN)

Will this person stay during your absence?

Details of Absence

Please provide details regarding the reason for your proposed absence

I will be absent from the dwelling

From (date)

To (date)

My address whilst absent from the dwelling will be

Address

Phone

Mobile

If you are temporarily going into a nursing home, a rehabilitation centre, respite care or a refuge and will be required to pay rent for your stay please provide details of this.
(Attach evidence to support the rent you will pay).

Weekly Rent amount

Tenancy Obligations

Whilst you are away your tenancy obligations under the Residential Tenancies Act 2010 should be met. These include:

Payment of rent
Payment of water usage accounts or other bills
Payment of water usage accounts or other bills

Please explain how these obligations will be met:

Will your household income change whilst you are away? Please explain

How will your rent be paid whilst you are away? Please explain

How will other accounts such as water accounts be paid? Please explain

Who will maintain the property as per the Residential Tenancy Agreement? (eg mow the grass, collect the mail). Please explain

Who will accept service of any notices which may be given under the Tenancy Agreement or Residential Tenancies Act 2010? You should appoint an agent using the Appointment of an Agent form

Declaration

I understand that, during my absence, I am responsible for meeting the obligations of my Residential Tenancy Agreement.

I have appointed an agent to accept service of any notices which may be given to me as a tenant under the Tenancy Agreement, or under the Residential Tenancies Act 2010.

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.

Wentworth tenants and clients come from all walks of life.

Read about them here.

Tenants

Tenants

Tenant Information

Current Household Members

Person 1

Person 2

Person 3

Person 4

Person 5

Details of Absence

Tenancy Obligations

Declaration

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.

(02) 4777 8000

admin@wentworth.org.au

Borec House,
Suite 1002, Level 1
29-57 Station Street
Penrith 2750

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