Tribunal Use Only
Member’s Name Member’s
Signature
Date Order Made
Premises Residential: Yes / No Hearing Notice Served: Yes / No
Agreement Regulated: Yes / No
Oral / Written
Application Received Within Time : Yes / No
(s88(4) before termination date)
(s83(2) Reg 22, 30 days after termination date)
Notice to Vacate valid: Yes / No
Appearance Tenant: Yes / No Appearance Respondent: Yes / No
REQUIREMENTS FOR TERMINATION NOTICE UNDER S.82 & 88
TERMINATION FOR BREACH - CIRCUMSTANCES OF THE CASE S.87(5)
1. Nature of the breach: …………………………………………………………………………………………………………….
2. Any previous breaches: ………………………………………………………………………………………………………….
3. Steps taken by tenant to remedy the breach: ………………………………………………………………………………...
4. Steps taken by the landlord about the breach: ………………………………………………………………………………..
5. Previous history of the tenancy: ………………………………………………………………………………………………..
Residential premises …………………………………………………………………………………………………………...
The termination and vacant possession date s.82(1), s.83(1) (not earlier than 14 days after the day on which
notice given)……………………………………………………………………………………………………………………..
The grounds, eg. rent unpaid for not less than 14 days before the notice given ……………………………………….
In writing …………………………………………………………………………………………………………………………
Signed by party giving notice …………………………………………………………………………………………………
Notice to tenant: that tenant is not required to vacate if tenant pays all rent owing or enters into and fully complies
with an agreed payment plan (s88) …………………………………………………………………………………………...
Other grounds …………………………………………………………………………………………………………………..
Tick if agent
Has the landlord sought a finding that tenant has frequently failed to pay rent? Yes / No
Has tenant paid all rent owing? Yes / No
Has tenant entered into agreed payment plan? Yes / No
Has tenant complied with agreed payment plan? Yes / No
Has tenant frequently failed to pay rent owing? Yes / No
Are you making a finding under s.89(5)? Yes / No
S.89(5) FINDING
TERMINATION OF SOCIAL HOUSING TENANCY S.154E
1. Effect of tenancy on neighbouring residents or others: ………………………………………………………………...……
2. Likelihood that neighbours or others will suffer serious adverse effects if tenancy not terminated: …………………….
3. Landlord’s responsibility to other tenants: ……………………………………………………………………………………..
4. History of current/any prior SH tenancy with same/different landlord: ……………………………………………………..
5. Whether tenant is/has been in breach of Tribunal order: ……………………………………………………………………