Fillable Form 1: Rooming accommodation agreement (Form R18) (Department of the Environment and Energy)

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Form 1: Rooming accommodation agreement (Form R18) (Department of the Environment and Energy)

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Page 1 of 7 v9 Sep21
Level 11, Midtown Centre, 150 Mary Street | GPO Box 390 Brisbane Q 4001 | t 1300 366 311 | rta.qld.gov.au
Rooming accommodation agreement (Form R18)
Residential Tenancies and Rooming Accommodation Act 2008
Part 1 Rooming accommodation details
Item
1
1.1 Address of the rental premises
Room no.
Postcode
1.2 Type of rooming accommodation (tick
if applicable)
Level 1
Level 2
Level 3
Student accommodation
1.3 Agent or manager/provider
Name/trading name
Address
Postcode
1.4 Phone Mobile Email
Item
2
2.1 Resident/s
Resident 1 Full name/s
Phone Email
Resident 2 Full name/s
Phone Email
2.2 Address for service (if different from address of the premises in item 1.1).
Attach a separate list
Item
3
3.1 Manager/provider’s agent
If applicable. See clause 28
Name/trading name
Address
Postcode
3.2 Phone Mobile Email
Item
4
4.1 Resident’s representative for notices
If applicable. See clause 29
Name/trading name
Address
Postcode
4.2 Phone Mobile Email
Item
5
Notices may be given to
(Indicate if the email is different from item 1, 2, 3 or 4 above)
5.1 Agent or manager/provider
Email Yes
No Facsimile Yes No
5.2 Resident/s
Email Yes
No Facsimile Yes No
5.3 Provider’s agent
Email Yes
No Facsimile Yes No
5.4 Resident’s representative
Email Yes
No Facsimile Yes No
Item
6
6.1 Inclusions provided
Insert inclusions, for example, furniture or other household goods let with the premises. Attach list if necessary.
Reset form
Print form
Rooming accommodation agreement (Form R18)
Residential Tenancies and Rooming Accommodation Act 2008
Page 2 of 7 v9 Sep21
Level 11, Midtown Centre, 150 Mary Street | GPO Box 390 Brisbane Q 4001 | t 1300 366 311 | rta.qld.gov.au
Item
7
7.1 The term of the agreement is
fixed term agreement periodic agreement
7.2 Starting on 7.3 Ending on
Fixed term agreements only. For continuation of agreement, see clause 5
Item
8
Rent
per
week fortnight
See clause 6(1)
Item
9
Breakdown of rent
See clause 3(1e). Please break down amount of rent for each – in either percentage or dollar values.
Accommodation
Other services
(attach a list if necessary)
Food service
Personal care service
See clause 30
N.B The manager/provider/agent acknowledges they do not receive any government funding on behalf of the resident for the services charged
for in the breakdown above.
Item
10
Rent must be paid on the
day of each
Insert day. See clause 6(2) Insert week/fortnight
Item
11
Method of rent payment
Insert the way the rent must be paid. See clause 6(3)
Details for direct credit
Bank/building society/credit union
BSB no. Account name
Account no. Payment reference
Item
12
Place of rent payment
Insert where the rent must be paid. See clause 6(4) to 6(6)
Item
13
13.1 Can the rent be increased?
Yes No
13.2 How will the rent increase be calculated?
13.3 When will the rent increase start?
Starting on
See clause 8
Item
14
Rental bond amount
$
See clause 11
Item
15
Services to be provided
Attach list if necessary
Item
16
Utility services for which the resident must pay
See clause 13
Item
17
House rules have been provided to the resident/s
Yes No
See clause 16
Item
18
18.1 Number of persons allowed to reside in the room
18.2 Number of persons allowed to reside at the rental premises
See clause 17
Item
19
19.1 Pets approved
Yes No
See clause 18(1)
19.2 The types and number of pets that may be kept See clause 18(2)
Type Number Type Number
Rooming accommodation agreement (Form R18)
Residential Tenancies and Rooming Accommodation Act 2008
Page 3 of 7 v9 Sep21
Level 11, Midtown Centre, 150 Mary Street | GPO Box 390 Brisbane Q 4001 | t 1300 366 311 | rta.qld.gov.au
Part 2 Standard Terms
Division 1 Preliminary
1 Interpretation
In this agreement –
(a) a reference to the rental premises includes a reference
to any inclusions for the rental premises stated in this
agreement for item 6.1; and
(b) a reference to a numbered section is a reference to the
section in the Act with that number; and
(c) a reference to a numbered item is a reference to the item
with that number in part 1; and
(d) a reference to a numbered clause is a reference to the
clause of this agreement with that number.
2 Terms of a rooming accommodation
agreement
(1) This part states, under the Residential Tenancies and Rooming
Accommodation Act 2008 (the Act), section 73, the standard
terms of a rooming accommodation agreement.
(2) The Act also imposes duties on, and gives entitlements to, the
provider and resident that are taken to be included as terms
of this agreement.
(3) The house rules for the rental premises are taken to be included
as terms of this agreement.
(4) The provider and resident may agree on other terms of this
agreement (special terms).
(5) A duty or entitlement under the Act overrides a standard term
or special term if the term is inconsistent with the duty or
entitlement.
(6) A standard term overrides a special term if they are inconsistent.
Note –
Some breaches of this agreement may also be an offence under the
Act, for example, if –
• the provider or the provider’s agent enters the resident’s room in
contravention of the rules of entry under sections 257 to 262; or
• the resident does not sign and return the condition report to the
provider or the provider’s agent under section 81.
Division 2 Period of rooming accommodation
agreement
3 Start of rooming accommodation agreement
(1) Written agreement required s77 (4)
The agreement must—
(a) be written in a clear and precise way; and
(b) state the provider’s name, address and any telephone
number and the resident’s name and any telephone number;
and
(c) fully describe the services to be provided under the
agreement; and
(d) state the amount of rent payable, when it is payable and
how it must be paid; and
(e) state the components of the rent attributable to
accommodation, a food service, a personal care service or
another service; and
(f) state the amount of any rental bond payable; and
(g) for a fixed term agreement, state the term for which it
applies; and
(h) be signed by the parties; and
(i) comply with any other requirement prescribed under a
regulation.
(2) This agreement starts on the day stated in this agreement for
item 7.2.
4 Entry condition report – s 81
(1) This clause applies only if a rental bond is payable, or has been
paid, under this agreement.
(2)
The provider must prepare, in the approved form, sign and give
the resident 1 copy of a condition report for the room.
(3)
The copy must be given to the resident on or before the day
the resident occupies the room under this agreement.
(4)
The resident must mark the copy of the report to show any
parts the resident disagrees with, and sign and return the
copy to the provider not later than 3 days after the later of the
following days –
(a)
the day the resident is entitled to occupy the room;
(b)
the day the resident is given the copy of the condition report.
Note –
A well completed condition report can be very important to help the
parties if there is a dispute about the condition of the room when the
rooming accommodation agreement started.
(5) After the copy of the condition report is returned to the provider
by the resident, the provider must copy the condition report
and return it to the resident within 14 days.
5 Continuation of fixed term agreement – s 82
(1) This clause applies if –
(a)
under this agreement, rooming accommodation is provided
to the resident for a fixed term; and
(b) neither the provider nor the resident gives the other party
a notice under chapter 5, part 2 ending the agreement or
agrees in writing with the other party to end the agreement.
(2) This agreement continues to apply after the last day of the term,
as a periodic agreement, on the same terms on which it applied
immediately before the last day of the term, other than the term
about the fixed term.
Division 3 Rent
6 When, how and where rent must be paid
– ss 98 and 100
(1) The resident must pay the rent stated in this agreement for
item 8.
(2) The rent must be paid at the times stated in this agreement for
item 10.
(3) The rent must be paid –
(a) in the way stated in this agreement for item 11; or
(b) in the way agreed after the signing of this agreement by –
(i) the provider or resident giving the other party a notice
proposing the way; and
(ii) the other party agreeing to the proposal in writing; or
(c) if there is no way stated in this agreement for item 11 or
no way agreed after the signing of this agreement – in an
approved way under section 98(4).
Note –
If the way rent is to be paid is another way agreed on by the provider
and resident under section 98(4)(g), the provider or the provider’s agent
must comply with the obligations under section 99(2).
(4) The rent must be paid at the place stated in this agreement
for item 12.
(5) However, if, after the signing of this agreement, the provider
gives a notice to the resident stating a different place for
payment and the place is reasonable, the rent must be paid
at the place while the notice is in force.
(6) If no place is stated in this agreement for item 12 and there
is no notice stating a place, the rent must be paid at an
appropriate place.
Examples of an appropriate place –
• the provider’s address for service
• the provider’s agent’s office.
7 Rent in advance – s 101
The provider may require the resident to pay rent in advance
only if the payment is not more than 2 weeks rent.
Note –
Under section 101(2), the provider or the provider’s agent must not
require a payment of rent under this agreement in a period for which
rent has already been paid.
Rooming accommodation agreement (Form R18)
Residential Tenancies and Rooming Accommodation Act 2008
Page 4 of 7 v9 Sep21
Level 11, Midtown Centre, 150 Mary Street | GPO Box 390 Brisbane Q 4001 | t 1300 366 311 | rta.qld.gov.au
8 Rent increases – s 105
(1) If a provider proposes to increase the rent, the provider must
give notice of the proposal to the resident.
(2) The notice must state –
(a) the amount of the increased rent; and
(b) the day, not earlier than 4 weeks after the day the notice is
given, from which the increased rent is payable.
(3) Also, if this agreement is for a fixed term, the rent may not be
increased before the term ends unless –
(a) this agreement states for item 13.1 rent can be increased;
and
(b) this agreement states for item 13.2 the amount of the
increase or how the amount of the increase is to be worked
out; and
(c) the increase is made in accordance with this agreement.
(4) The resident is not required to pay the increase unless it is
made in accordance with this clause.
(5) Subclauses (1) to (4) do not apply if the parties amend this
agreement to provide for another service to be provided by
the provider to the resident and for an increase in the rent in
payment of the service.
9 Rent decreases for matters including loss of
amenity or service – s 106
(1) This clause applies if –
(a) the resident’s room or common areas become partly unfit to
live in, or their amenity or standard substantially decreases,
other than because of intentional or reckless damage
caused by the resident or a guest of the resident; or
(b) a service provided to the resident under this agreement
is no longer available or is withdrawn, or the standard of
the service substantially decreases, other than because
the resident has not met the resident’s obligations under
this agreement.
(2) The rent payable under this agreement decreases by the
amount, and from the time, agreed between the provider and
the resident.
(3) If the provider and the resident can not agree on the amount
or time for the decrease, either of them may apply to a tribunal
for an order decreasing the rent by a stated amount from a
stated time.
10 Rent decreases because of resident’s absence
– s 107
(1) This clause applies if either of the following is not provided to
the resident because of the resident’s absence –
(a) a personal care service;
(b) a food service, but only if the resident is absent from
the rental premises for a continuous period of more than
2 weeks.
(2) The provider and the resident may agree to a reduction in rent
for the period of the absence.
(3) If the provider and the resident can not agree on a reduction
in rent for the period of the absence, the resident may apply to
a tribunal for an order decreasing the rent by a stated amount
for the period.
Division 4 Rental bond
11 Rental bond required – ss 111 and 116
(1) If a rental bond is stated in this agreement for item 14, the
resident must pay to the provider or the provider’s agent the
rental bond amount –
(a) if a special term requires the bond to be paid at a stated
time – at the stated time; or
(b) if a special term requires the bond to be paid by instalments
– by instalments; or
(c) otherwise – when the resident signs this agreement.
Note –
There is a maximum bond that may be required unless your weekly rent
is more than $500. See section 146.
(2) The provider or the provider’s agent must, within 10 days of
receiving the bond or a part of the bond, pay it to the authority
and give the authority a notice, in the approved form, about the
bond.
(3) The bond is intended to be available to financially protect the
provider if the resident breaches this agreement.
Example –
The provider may claim against the bond if the resident does not
leave the room in the required condition at the end of the rooming
accommodation agreement.
Note –
For how to apply to the authority or a tribunal for the bond at the end
of the rooming accommodation agreement, see sections 125 to
141. Delay in applying may mean that payment is made on another
application for payment.
12 Increase in bond – s 154
(1) The resident must increase the rental bond if –
(a) the rent increases and the provider gives notice to the
resident to increase the bond; and
(b) the notice is given at least 11 months after –
(i) this agreement started; or
(ii) if the bond has been increased previously by a notice
given under this clause – the day stated in the notice,
or the last notice, for making the increase.
(2) The notice must state the increased amount and the day by
which the increase must be made.
(3) For subclause (2), the day must be at least 1 month after the
resident is given the notice.
Division 5 Outgoings
13 Charge for utility service – s 170
The resident must pay an amount for utility services supplied
to the rental premises during this agreement if –
(a) the service is stated in this agreement for item 16; and
(b) the resident’s room is individually metered for the utility
service by an appliance approved by the supplying entity.
Note –
Section 170(2)(b) limits the amount the resident must pay.
Division 6 Rights and obligations of provider
and resident
14 Provider’s obligations – ss 247 and 249
(1) The provider has the following obligations –
(a) to ensure the provider is not in breach of a law dealing
with issues about the health or safety of persons using or
entering the resident’s room or common areas;
(b) to take reasonable steps to ensure the resident –
(i) always has access to the resident’s room and to
bathroom and toilet facilities; and
(ii) has reasonable access to any other common areas;
(c) to take reasonable steps to ensure the security of the
resident’s room and the resident’s personal property in the
room;
(d) to maintain the resident’s room and common areas in a way
that the room and areas remain fit for the resident to live in;
(e) to take reasonable steps to ensure the resident’s room
and common areas and facilities provided in the room
and areas –
(i) are kept safe and in good repair; and
(ii) subject to any agreement with the resident about
cleaning the resident’s room or common areas or
facilities – are kept clean;
Rooming accommodation agreement (Form R18)
Residential Tenancies and Rooming Accommodation Act 2008
Page 5 of 7 v9 Sep21
Level 11, Midtown Centre, 150 Mary Street | GPO Box 390 Brisbane Q 4001 | t 1300 366 311 | rta.qld.gov.au
(f) not to unreasonably restrict the resident’s guests in visiting
the resident;
(g) to ensure that the times during which the provider, or
an agent of the provider, is available to be contacted
by the resident are reasonable, having regard to all the
circumstances including the services being provided to the
resident under this agreement.
(2) For subclause (1)(e)(ii), an agreement about cleaning common
areas may be made only for a common area used by the
resident and a minority of other residents of the provider.
Example for subclause (2) –
Four residents have individual rooms opening out onto a living area
which is available for use only by those residents. The provider and the
4 residents may agree that the cleaning of the living area is to be done
by the 4 residents.
(3) The provider must take reasonable steps to ensure the resident
has quiet enjoyment of the resident’s room and common areas.
(4) The provider or the provider’s agent must not interfere with the
reasonable peace, comfort or privacy of the resident in using
the resident’s room and common areas.
15 Resident’s obligations – s 253
(1) The resident has the following obligations –
(a) to use the resident’s room and common areas only or mainly
as a place of residence;
(b) not to use the resident’s room or common areas for an illegal
purpose;
(c) not to interfere with, and to ensure the resident’s guests do
not interfere with, the reasonable peace, comfort or privacy
of another resident or another resident’s appropriate use of
the other resident’s room or common areas;
(d) to pay the rent when it falls due;
(e) not to keep an animal on the rental premises without the
provider’s permission;
(f) not to intentionally or recklessly damage or destroy, or allow
the resident’s guests to intentionally or recklessly damage
or destroy, any part of the rental premises or a facility in the
rental premises;
(g) to keep the resident’s room and inclusions clean, having
regard to their condition at the start of this agreement;
(h) to maintain the resident’s room in a condition that does
not give rise to a fire or health hazard;
Examples of a fire hazard –
1 allowing newspapers to build up in the resident’s room
2 blocking access to the resident’s room.
16 House rules – ss 266–276
(1) The resident must comply with the house rules for the rental
premises.
(2) The provider must give the resident a copy of the house rules
for the rental premises before entering into this agreement.
(3) The provider or the provider’s agent for the rental premises
must ensure a copy of the house rules for the rental premises is
displayed, at all times, at a place in the rental premises where
it is likely to be seen by the residents.
(4) At least 7 days before making any changes to the house rules
for the rental premises, the provider must give a notice to the
resident stating the following –
(a) proposed changes and the day the changes are to take
effect;
(b) that the resident may object to the changes and how an
objection may be made.
(5) However, if this agreement starts less than 7 days before
the proposed changes are to take effect, the provider need
only give the notice mentioned in subclause (4) when this
agreement starts.
17 Number of occupants allowed
(1) No more than the number of persons stated in this agreement
for item 18.1 may reside in the room.
(2) No more than the number of persons stated in this agreement
for item 18.2 may reside at the rental premises.
(3) However, more people may reside in the room or at the rental
premises if the resident and the provider agree.
18 Pets
(1) The resident may keep pets on the rental premises only if this
agreement states for item 19.1 that pets are approved.
(2) If this agreement states for item 19.1 that pets are approved
and this agreement states for item 19.2 that only –
(a) a particular type of pet may be kept, only that type may be
kept; or
(b) a particular number of pets may be kept, only that number
may be kept; or
(c) a particular number of a particular type of pet may be kept,
only that number of that type may be kept.
19 Supply of locks and keys – s 250
(1) The provider must supply and maintain all locks necessary to
ensure the resident’s room is reasonably secure.
(2) The provider must give the resident a key for each lock that
secures an entry to the following –
(a) the resident’s room;
(b) a building or building within which the resident’s room and
common areas are situated.
(3) The resident must not make a copy of the key without the
provider’s permission.
(4) The resident must not tamper with a door lock in the rental
premises.
20 Changing locks – s 251
(1) The resident may request the provider to change or repair a
lock that secures entry to the resident’s room if the resident
reasonably believes there is the likelihood of –
(a) risk to the resident’s safety; or
(b) theft of, or damage to, the resident’s belongings.
(2) The provider must not act unreasonably in failing to agree to
change or repair the lock.
21 Fixtures or structural changes – ss 254–256
(1) The resident may attach a fixture, or make a structural change,
to the rental premises only if the provider agrees to the fixture’s
attachment or the structural change.
Note –
Fixtures are generally items permanently attached to land or to a building
that are intended to become part of the land or building. An attachment
may include, for example, something glued, nailed or screwed to a wall.
(2) The provider’s agreement must be written, describe the nature
of the fixture or change and include any terms of this agreement.
Examples of terms –
• that the resident may remove the fixture
• that the resident must repair damage caused when removing
the fixture
• that the provider must pay for the fixture if the resident can not
remove it
(3) If the provider does agree, the resident must comply with the
terms of the provider’s agreement.
(4) The provider must not act unreasonably in failing to agree.
(5) If the resident attaches a fixture, or makes a structural change,
to the rental premises without the provider’s agreement, the
provider may –
(a) take action for a breach of a term of this agreement; or
(b) waive the breach (that is, not take action for the breach)
and treat the fixture or change as an improvement to the
rental premises for the provider’s benefit (that is, treat it
as belonging to the provider, without having to pay the
resident for it).
Rooming accommodation agreement (Form R18)
Residential Tenancies and Rooming Accommodation Act 2008
Page 6 of 7 v9 Sep21
Level 11, Midtown Centre, 150 Mary Street | GPO Box 390 Brisbane Q 4001 | t 1300 366 311 | rta.qld.gov.au
22 Provider’s right to enter resident’s room
– ss 257-262
The provider or the provider’s agent may enter the resident’s
room during this agreement only if the obligations under
sections 257 to 262 have been complied with.
Division 7 When agreement ends
23 Ending of agreement – s 366
(1) This agreement ends only if –
(a) the resident and the provider agree in writing; or
(b) the provider gives a notice to leave the rental premises to the
resident by a stated day and the resident leaves the rental
premises; or
(c) the provider or resident gives a notice to the other party
terminating this agreement on a stated day; or
(d) a tribunal makes an order terminating this agreement; or
(e) the resident abandons the resident’s room; or
Note –
See section 509 for indications that a resident has abandoned
their room.
(f) after receiving a notice from a mortgagee under section
384, the resident vacates, or is removed from, the rental
premises.
(2) Also, if a sole resident dies, this agreement terminates in
accordance with section 366(7) or (8).
24 Condition room must be left in – s 253(i)
At the end of this agreement, the resident must leave the
resident’s room and inclusions, as far as possible, in the same
condition they were in at the start of this agreement, fair wear
and tear excepted.
Examples of what may be fair wear and tear –
• wear that happens during normal use
• changes that happen with ageing
25 Keys
At the end of this agreement, the resident must return to the
provider all keys for the resident’s room and the rental premises.
26 Goods or money left behind in rental premises
– ss 392 and 393
(1) The resident must take all of the resident’s belongings from the
rental premises at the end of this agreement.
(2) The provider must not treat belongings left behind as the
provider’s own property, but must deal with them under sections
392 and 393.
Division 9 Miscellaneous
27 Supply of goods and services – s 176
(1) The provider or the provider’s agent must not require the
resident to buy goods or services from the provider or a person
nominated by the provider or agent.
(2) Subclause (1) does not apply to a requirement about a food
service, personal care service or utility service.
Note –
See section 176 for what is a utility service and schedule 2 of the Act
for what is a food service and a personal care service.
28 Provider’s agent
(1) The name and address for service of the provider’s agent is
stated in this agreement for item 3.
(2) Unless a special term provides otherwise, the agent may –
(a) stand in the provider’s place in any application to a tribunal
by the provider or the resident; or
(b) do any thing else the provider may do, or is required to do,
under this agreement.
29 Notices
(1) A notice under this agreement must be written and, if there is an
approved form for the notice, in the approved form.
(2) A notice from the resident to the provider may be given to the
provider’s agent.
(3) A notice may be given to a party to this agreement, the
provider’s agent or a representative –
(a) by giving it to the party, agent or representative personally; or
(b) if an address for service for the party, agent or representative
is stated in this agreement for item 1, 2, 3 or 4 – by leaving
it at the address, sending it by prepaid post as a letter to the
address; or
(c) if a facsimile number for the party, agent or representative
is stated in this agreement for item 1, 2, 3 or 4 and item
5 indicates that a notice may be given by facsimile – by
sending it by facsimile to the facsimile number in accordance
with the Electronic Transactions (Queensland) Act 2001; or
(d) if an email address for the party, agent or representative
is stated in this agreement for item 1, 2, 3 or 4 and item 5
indicates that a notice may be given by email – by sending
it electronically to the email address in accordance with the
Electronic Transactions (Queensland) Act 2001.
(4) A party, the provider’s agent or a representative may withdraw
his or her consent to notices being given to them by facsimile or
email only by giving notice to each other party that notices are
no longer to be given to the party, agent or representative by
facsimile or email.
(5) If no address for service is stated in this agreement for item 2 for
the resident, the resident’s address for service is taken to be the
address of the rental premises.
(6) A party, the provider’s agent or a representative may change his
or her address for service, facsimile number or email address
only by giving notice to each other party of a new address for
service, facsimile number or email address.
(7) On the giving of a notice of a new address for service, facsimile
number or email address for a party, the provider’s agent or
a representative, the address for service, facsimile number or
email address stated in the notice is taken to be the party’s,
agent’s or representative’s address for service, facsimile number
or email address stated in this agreement for item 1, 2, 3 or 4.
(8) Unless the contrary is proved –
(a) a notice left at an address for service is taken to have been
received by the party to whom the address relates when the
notice was left at the address; and
(b) a notice sent by post is taken to have been received by the
person to whom it was addressed when it would have been
delivered in the ordinary course of post; and
(c) a notice sent by facsimile is taken to have been received at
the place where the facsimile was sent when the sender’s
facsimile machine produces a transmission report indicating
all pages of the notice have been successfully sent; and
(d) a notice sent by email is taken to have been received by the
recipient when the email enters the recipient’s email server.
(9) In this clause –
representative means a person acting for the resident under
section 525(1)(c).
30 Dictionary – Schedule 2
personal care service means a service of regularly providing a
resident with—
(a) help in—
(i) bathing, toileting or another activity related to personal
hygiene; or
(ii) dressing or undressing; or
(iii) consuming a meal; or
(iv) meeting a mobility problem of the resident; or
(v) taking medication; or
(b) help in managing the resident’s financial affairs.
Page 7 of 7 v9 Sep21
Level 11, Midtown Centre, 150 Mary Street | GPO Box 390 Brisbane Q 4001 | t 1300 366 311 | rta.qld.gov.au
Rooming accommodation agreement (Form R18)
Residential Tenancies and Rooming Accommodation Act 2008
Part 3 Special terms
Insert any special terms here. See clause 2(4) to 2(6)
The resident/s must receive a copy of any applicable by-laws if copies have not previously been given to the resident/s.
Do not send to the RTA—give this form to the resident/s, keep a copy for your records.
Signature of the agent, manager/provider or provider’s agent
Name/trading name
Signature Date
Signature of resident 1
Indicate if acting on authority under Guardianship and Administration Act 2000 or Powers of Attorney Act 1998.
Print name
Signature Date
Signature of resident 2
Indicate if acting on authority under Guardianship and Administration Act 2000 or Powers of Attorney Act 1998.
Print name
Signature Date
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Form 1: Rooming accommodation agreement (Form R18) (Department of the Environment and Energy)

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Completed 27 March 2022

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