Additional applicant/household members Form – Please note this form is only to be used in addition to an Application for Public Housing Applicant __ or Person __ (Please cross out the option that does not apply) Personal details ID documents attached? Mr / Mrs / Ms / Miss / Yes No First name Middle name (s) Last name Alternative name Relationship to Relationship to Applicant 1 Applicant 2 Gender Female Male Date of birth Mobile phone Other phone Are you of Aboriginal and/or Torres Strait Islander origin? Yes No Aboriginal Torres Strait Islander If yes please specify Aboriginal and/or Torres Strait Islander Disability Yes No If yes please specify Physical Intellectual Psychological Sensory Other (please specify) …………………………………………………………………. Income and assets Evidence of weekly income (before tax) for each person in the house aged 18 years and over is required. Attach documents to confirm income received over the past three months as follows: Source of income Gross amount (before tax) Documents attached Wages Yes No Pension / Allowance Yes No Self-employment Yes No Workers compensation Yes No Other Yes No Asset details Gross amount (before tax) or Assets estimated current value Documents attached Bank account (s) Yes No Fixed term deposits Yes No Shares investments Yes No (includes accessible superannuation Boat / caravan / any other recreational Yes No vehicles Property and land / any other valuable Yes No saleable items
Additional applicant/household members – Form Please note this form is only to be used in addition to an Application for Public Housing Applicant __ or Person __ (Please cross out the option that does not apply) Personal details Mr / Mrs / Ms / Miss / ID documents attached? Yes No First name Middle name (s) Last name Alternative name Relationship to Applicant 1 Relationship to Applicant 2 Gender Female Male Date of birth Mobile phone Other phone Are you of Aboriginal and/or Torres Strait Islander origin? Yes No If yes please specify Aboriginal Torres Strait Islander Aboriginal and/or Torres Strait Islander Disability Yes No If yes please specify Physical Intellectual Psychological Sensory Other (please specify) …………………………………………………………………. Income and assets Evidence of weekly income (before tax) for each person in the house aged 18 years and over is required. Attach documents to confirm income received over the past three months as follows: Source of income Gross amount (before tax) Documents attached Wages Yes No Pension / Allowance Yes No Self-employment Yes No Workers compensation Yes No Other Yes No Asset details Assets Gross amount (before tax) or estimated current value Documents attached Bank account (s) Yes No Fixed term deposits Yes No Shares investments (includes accessible superannuation Yes No Boat / caravan / any other recreational vehicles Yes No Property and land / any other valuable saleable items Yes No
sf118-additional-household-members-form.docx