Housing Application Form

WOOMERA ABORIGINAL CORPORATION
ABN: 26 149 803 815 684
Daniel St (PO Box 19) Lavington NSW 2640
ICN: 1028
Email: [email protected]
Ph: 0260 577 400

Name of the Applicant*
Phone (Home)
Phone (Mobile)
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Email*
Date of Birth*
DD slash MM slash YYYY
Licence Number

Please attach a copy – if no licence, attach Birth Certificate
Upload Licence or Birth Certificate*
Max. file size: 512 MB.
Licence Date of Expiry
MM slash DD slash YYYY
Do you have a Confirmation of Aboriginality Certificate?*
If yes, please attach a copy of Confirmation of Aboriginality Certificate
Max. file size: 512 MB.
Housing type required*
Where are you currently housed*
If housed elsewhere, please specify
Whose name appears on the Tenancy Agreement where you are currently living?*
What is the Relationship of this person to you?*
How much weekly rent do you pay at your current address?*
Provide a current rent ledger or rent receipts*
Max. file size: 512 MB.
Do you currently own any other Housing?*
Total gross weekly household income*
of all adults in your household
Provide 2 payslips / Centrelink income & assets statement or group certificate as proof of income for all adults in your household*
Max. file size: 512 MB.
Do you require housing in a particular location?*
If Yes, please state why
Family Complement
Name Date of Birth Relationship to the Applicant

This should include applicant & all persons to be housed
Any special housing design needs
- Ramp required (wheelchair or walking frame)
- Special taps (ie. Persons with arthritis)
- Inability to climb stairs
- Inability to use standard bath or toilet
- Dialysis Machine
Please state other special needs
How many bedrooms do you require?
I give Woomera Aboriginal Corporation consent to make appropriate enquiries in relation to my rental and employment history so they can make an informed decision on my eligibility for housing with their organisation.*

Please write your full name above

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Name	Date of Birth	Relationship to the Applicant