Fillable ide My Details Consent to Prov A. Address (New South Wales)

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ide My Details Consent to Prov A. Address (New South Wales)

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Country of origin: AUSTRALIA
File type: PDF

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Consent to Prov
ide My Details
A. Address of Rental Premises
Unit No: Street
No:
Street
Name:
Suburb: Postcode:
B. Landlord Details
Name: Mobile:
Email:
C. Agent Details
Name: Mobile:
Email:
Agency:
D. Tenant Details
Name: Mobile:
Email:
Name: Mobile:
Email:
Name: Mobile:
Email:
Name: Mobile:
Email:
I/We the Ten
ants named at Section D above hereby:
1.
authorises the Department of Customer Service (the Department) to collect our
personal
information as contained in this docum
ent from the Landlord/Agent named at Section
s B and
C abo
ve for the purpose of determining an application by the La
ndlord/Agent for the
Re
sidential Tenancy Support Payment (the Payment) and for the purpose of ensuri
ng that
person
s who are granted the Payment are not also granted the COVID-19 land
tax benefit
and for relate
d purposes; a
nd
2.
consents to the Department disclosing their personal information as containe
d in this
document to other NS
W Government agencies or to other State, Territory
and
Comm
onwealth agencies for those purposes.
Dated:
Tenant’s Name: Tenant’s Signature:
Tenant’s Name: Tenant’s Signature:
Tenant’s Name: Tenant’s Signature:
Tenant’s Name: Tenant’s Signature:
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ide My Details Consent to Prov A. Address (New South Wales)

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Completed 18 August 2021

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