Page 1 of 2 v1 Apr20
Level 23, 179 Turbot Street | GPO Box 390 Brisbane Q 4001 | t 1300 366 311 | rta.qld.gov.au
Domestic and Family Violence
Notice ending tenancy
COVID-19 Emergency Response Act 2020 (Section 24)
Residential Tenancies and Rooming Accommodation (COVID-19 Emergency Response) Regulation 2020 (Sections 22 and 27)
Tenants experiencing domestic and family violence can use this form to end their interest in a tenancy agreement (Part A) and supply
appropriate evidence to support their circumstances (Part B).
The agent/lessor must not inform any remaining co-tenants until 7 days after the date this notice is issued.
PART A: Ending your tenancy obligations
1 Address of the rental property
Postcode
2 Notice issued by
Full name of departing tenant
Phone Mobile
Date
Email
Note: if there is more than one tenant departing on domestic and family violence grounds, please complete a separate form for
each tenant.
3
Notice issued to
Agent Lessor
Full name/trading name
Address
Postcode
4 Notice issued on
Day Date Method of issue (e.g. email, post, in person)
5 I intend to vacate the property by midnight on
(you must provide minimum 7 days notice and pay rent for those 7 days but you can leave at any time)
Do not send to the RTA—give this form to the lessor/agent and keep a copy for your records.
Note: this form can only be used until 31 December 2020 as stated in section 3 of the Residential Tenancies and Rooming
Accommodation (COVID-19 Emergency Response) Regulation 2020.
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Page 2 of 2 v1 Apr20
Level 23, 179 Turbot Street | GPO Box 390 Brisbane Q 4001 | t 1300 366 311 | rta.qld.gov.au
Domestic and Family Violence
Notice ending tenancy
COVID-19 Emergency Response Act 2020 (Section 24)
Residential Tenancies and Rooming Accommodation (COVID-19 Emergency Response) Regulation 2020 (Sections 22 and 27)
PART B: Providing evidence to lessor/agent
You are required to provide documentation to support your claim of experiencing domestic and family violence. You can
choose to provide a copy of relevant documentation or allow your lessor/agent to inspect it.
Please indicate how you intend to show supporting documentation:
I intend to show my lessor/agent supporting documentation.
I have included a copy of supporting documentation with this form
My supporting documentation is:
a protection order or temporary protection order;
a police protection note;
an interstate order;
an injunction for person protection under the Family Law Act 1975 (Commonwealth);
a Domestic and Family Violence Report signed by an authorised professional
Your agent or manager/provider is required to ensure your privacy
They cannot take a copy of your evidence but you may provide a copy.
If the tenant gives you this form, you must ensure this and other domestic and family violence infromation is kept in
a secure manner.
They must not disclose information about your domestic and family violence to anyone unless required by law to
do so.
Co-tenants may not be the alleged perpetrator/s, however it is important that the departing tenant should only be
contacted using the updated details they have provided.
Contact details provided by the departing tenant MUST NOT be passed on to anyone else, unless required by law
to do so.
Penalties apply to manager/provider or agent who do not follow these requirements.
Who is an authorised professional?
Under the Residential Tenancies and Rooming Accommodation (COVID-19 Emergency Response) Regulation 2020 an authorised
professional refers to any of the following:
(i) a doctor;
(ii) a social worker;
(iii) a refuge or crisis worker;
(iv) a domestic and family violence support worker or case manager;
(v) an Aboriginal and Torres Strait Islander medical service;
(vi) a solicitor.
Do not send to the RTA—give this form to the lessor/agent and keep a copy for your records.
Note: this form can only be used until 31 December 2020 as stated in section 3 of the Residential Tenancies
and Rooming Accommodation (COVID-19 Emergency Response) Regulation 2020.
This form is to be used by a tenant to end their tenancy early because they are experiencing domestic and family violence.
Tenants experiencing domestic and family violence must provide seven days notice. They can leave before 7 days but they
are responsible for paying rent until the end of the 7 day notice period. They are not liable for any other costs and can request
their rental bond contribution be refunded to them.
When serving notices by post, the sender must allow time for the mail to arrive when working out notice periods.
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