Resource Communities Affordable Housing Application
1. Affordable Housing Eligibility
Before completing the application form, please ensure that you meet the eligibility criteria outlined below:
 Must be an Australian Citizen or are otherwise eligible to work within Australia; and
 must be approved as a tenant by Horizon Housing under normal suitability assessments; and
 must have an ongoing contract of employment within the relevant local government areas; a letter of
employment, or be retired; or
 be over 55 and have lived in the relevant local government area for more than six months previously; and
 must not have a household income in excess of the maximum gross weekly income as set out below:
Upper limit at tenancy commencement
Household Type
1 Adult
2 Adults
3 Adults
Sole Parent & 1 Child
Sole Parent & 2 Children
Sole Parent & 3 Children
Couple & 1 Child
Couple & 2 Children
Couple & 3 Children
Weekly
Annually
$1105
$1527
$2250
$1528
$1895
$2261
$1894
$2260
$2627
$57,445
$79,419
$117,000
$79,474
$98,528
$117,581
$98,473
$117,526
$136,580
For household types not identified in the above table, the following income limits apply:
First Single Adult
Each Additional Adult
Sole Parent
Each Child
$1105
$423
$1162
$366
$57,445
$21,974
$60,420
$19,054
If your income falls just outside of these limits, your case will be assessed on the merit of the overall application.
Address
42A Wyndham Street, Roma Qld 4455 (PO Box 946 Roma Qld 4455)
Phone
(07) 5668 9400
Fax
(07) 5571 0732
Email
[email protected]
2. List of items you are required to forward to Horizon Housing
a)
b)
c)
d)
e)
f)
g)
h)
i)
Application Form (attached)
Real Estate/Lessor Tenancy Information Request (attached)
NOTE: If Applicants have lived separately prior to this application, please complete 2 copies of this form
Identification as per the Proof of Identification List (below)
Proof of Income (6 latest pay slips and a letter from your Employer stating your Gross Income)
Copy of temporary protection or bridging visa (if not an Australian citizen or you do not have permanent
residency)
Centrelink Income Statement (if applicable)
Rental Receipts (6) or a Rental Ledger for 6 weeks period to current date
Bank Statement
Proof of Offer of employment within the local Regional Council area
(including New employer contact details – so we can verify your new position)
Proof of Identification
To prove your identity with Horizon Housing, you are required to provide either:
2 items from the Primary list
OR
1 item from the Primary list and 3 items from the Secondary list below.
Primary Identification
Secondary Identification
18+ Card with Photograph
Driver’s License with Photograph
Full Birth Certificate or extract
Naturalisation or Citizenship certificate
Passport
Bank, Credit Card or ATM card with your signature
Medicare Card
Pensioner Health Benefits Card
Student Card with photograph
Centrelink document with your name & Customer Reference Number
Motor Vehicle registration showing your name, current address and
proof of payment
Please ensure all documents requested are submitted. Incomplete applications will not be processed.
Send your application and all paperwork to one of the following:
Mail:
Horizon Housing, PO Box 946, Roma Qld 4455
42A Wyndham Street, Roma Qld 4455
Email:
[email protected]
Affordable Housing - Application Form
Applicant 1 Details
Name
Date of Birth
Current Address
Email Address
Phone
Home
Mobile
Employer
Job Title
Duration of Employment
Full Time Work
Income
Part Time Work
Casual Work
Contact Name
Student
Other (Benefit / Pension)
Phone Number
Applicant 2 Details
Name
Date of Birth
Current Address
Email Address
Phone
Home
Mobile
Employer
Job Title
Duration of Employment
Full Time Work
Income
Part Time Work
Casual Work
Contact Name
Student
Other (Benefit / Pension)
Phone Number
Persons covered by this application:
Number of Adults
(including You)
Names of other persons
Children
Please list all people who will be living with
you (excluding those listed above)
Date of Birth Relationship to Applicant/s
Housing Requirements
Number of Bedrooms
Backyard
Yes / No
Garage
Yes / No
Other requirements
Do you have Pets?
Yes / No
Number
Type/s of Pets *
* (Pets will be considered on a case by case basis and will be dependent on instructions from the owners.)
Address
42A Wyndham Street, Roma Qld 4455 (PO Box 946 Roma Qld 4455)
Phone
(07) 5668 9400
Fax
(07) 5571 0732
Email
[email protected]
Stairs
Yes / No
Applicant 1 Rental History
Current Rental Address
Duration of Tenancy
Rent Paid (weekly)
Reason for wanting to leave
Rental
Private Rental
Real Estate
Living with Family
Other:
Contact Name
Phone Number
Fax / Email
Previous Rental Address
Duration of Tenancy
Rent Paid (weekly)
Reason for leaving
Rental
Private Rental
Real Estate
Living with Family
Other:
Contact Name
Phone Number
Fax / Email
Applicant 2 Rental History
Current Rental Address
Duration of Tenancy
Rent Paid (weekly)
Reason for wanting to leave
Rental
Private Rental
Real Estate
Living with Family
Other
Contact Name
Phone Number
Fax / Email
Previous Rental Address
Duration of Tenancy
Rent Paid (weekly)
Reason for leaving
Rental
Private Rental
Real Estate
Living with Family
Other
Contact Name
Phone Number
Fax / Email
Next of Kin / Emergency Contact Details
Emergency Contact
Phone
Home
Mobile
I am interested in renting a property through the affordable housing project. I declare to the best of my knowledge, the
information I have provided on this form and in conjunction with this form is true and correct. I understand that completing this
form does not constitute an offer of housing, and I will be contacted to view a property prior to my application being screened.
Signature
Name
Date
Signature
Name
Date
Real Estate/Lessor Tenancy Information Request
I/We the applicants, authorise Horizon Housing Co Ltd to conduct a reference check from the previous agent or
lessor in order to allow processing of our Tenancy Application Form.
Name of Applicant/s
Property Address
Signature/s
Applicant 1
Applicant 2
Agent/Lessor Name
Fax Number
PLEASE NOTE: THIS BELOW SECTION IS TO BE COMPLETED BY PREVIOUS AGENT/LESSOR
The applicant/s listed above has/have applied to lease one of our rental properties and has given your name as a
landlord. Please complete the following and return with a copy of the Tenant’s ledger to Fax (07) 5571 0732.
What was the weekly rent?
$
Duration of Tenancy
Months/Years
Is/was the above applicant a tenant at the address stated?
Yes □
No □
Were there other tenants on the lease?
Yes □
No □
Was the tenancy terminated by your office?
Yes □
No □
Were any “Form 11 - Notice to Remedy Breach” issued to the Tenant?
Yes □
No □
If yes, reason why:
How many?
Was a “Form 12 – Notice to Leave” issued?
Yes □
No □
Were periodic inspections carried out?
Yes □
No □
Were the property/lawns/gardens kept in a neat & tidy condition
Yes □
No □
Yes □
No □
Yes □
No □
Were the pets well kept?
Yes □
No □
Would you recommend these applicants as good tenants?
Yes □
No □
If yes, reason why:
If yes, reason why:
If no, list problems:
Was the bond refunded in full? Or will it be?
If no, reason why
Were there pets kept at the property?
If yes, how many & what type?
Agent Name
Number:
Type
Signature
Phone