v5 Oct16
Level 23, 179 Turbot Street | GPO Box 390 Brisbane Q 4001 | t 1300 366 311 | rta.qld.gov.au
4
Refund of rental bond (Form 4)
Residential Tenancies and Rooming Accommodation Act 2008
(Sections 125–141)
Lodge form online (rta.qld.gov.au) or by post. Do not email this form.
1
Address of rental property (rooming accommodation: include room number)
Postcode
2 Only send this form to the RTA if:
• notice ending the tenancy has expired Expiry date
OR
• notice was not issued and the tenants have vacated Date vacated
OR
• bond has decreased New weekly rent
$
3 Tenants refund details (include individual amounts)
The RTA is collecting your personal information for the purpose of carrying out the RTA’s functions under the Residential Tenancies and Rooming Accommodation Act 2008 and
may provide your information to QCAT and other bodies. For more information see RTA website.
Rental bond number
First name/s Last name RTA ID (if known)
Date of birth Phone Mobile
Forwarding address Postcode
Email
$
Refunds only paid into Australian bank accounts (no cheques) Date
If the amount above is blank
do not sign
Name of account holder
Signature
BSB no. Account no.
First name/s Last name RTA ID (if known)
Date of birth Phone Mobile
Forwarding address Postcode
Email
$
Refunds only paid into Australian bank accounts (no cheques) Date
If the amount above is blank
do not sign
Name of account holder
Signature
BSB no. Account no.
If more than 2 tenants complete a second form.
4
Property manager/owner refund details
Full name/trading name
Phone Mobile RTA ID (if known)
Postal address Postcode
Email
$
Refunds only paid into Australian bank accounts (no cheques) Date
Name of account holder
Signature
BSB no. Account no.
Details of claim/amounts
5
Total bond
held by the RTA $
The RTA is not liable for any losses that occur if you provide incorrect information.
