Is the tenant or a Yes No If yes, when is the baby Estimated due date: household member due? pregnant? Current tenancy information Housing Provider Worker name Telephone Tenancy start date Tenancy reference no. Current weekly rent $ Current account balance $ CR / DR Legal action pending Yes No If yes, what action VCAT hearing pending Yes No Date of hearing Last home visit Last contact Financial Income source, including Centrelink Fortnightly $ realisable assets, for Gross wages $ example; Centrelink, wages, investments Investments Gross interest/earnings $ Other $ Previous tenancy charges Rental arrears $ Maintenance arrears $ DHHS Bond loan/s outstanding $ Outstanding debts if Creditor: $ known Centrelink, electricity, bank, other Identified risk and support needs Risk/Support need type Please check Risk/support needs details relevant box Family Violence Forgotten Australian/Care Leaver related issues
Is the tenant or a household member pregnant? Yes No If yes, when is the baby due? Estimated due date: Current tenancy information Housing Provider Worker name Telephone Tenancy start date Tenancy reference no. Current weekly rent $ Current account balance $ CR / DR Legal action pending Yes No If yes, what action VCAT hearing pending Yes No Date of hearing Last home visit Last contact Financial Income source, including realisable assets, for example; Centrelink, wages, investments Centrelink Fortnightly $ Gross wages $ Investments Gross interest/earnings $ Other $ Previous tenancy charges Rental arrears Maintenance arrears DHHS Bond loan/s outstanding $ $ $ Outstanding debts if known Creditor: Centrelink, electricity, bank, other $ Identified risk and support needs Risk/Support need type Please check relevant box Risk/support needs details Family Violence Forgotten Australian/Care Leaver related issues