Property Services - Exit Form

Property Services - Exit Form

This form is to be completed & signed by Case Worker or their Manager and sent to the Tenancy Administration Officer for the property identified below.

Unless this form is completed the property will not be considered vacant.

To:
From: / Organisation:
Tenants Name:
Address: / P/Code
DateTenancy Commenced: / / /
Date Tenancy Completed: / / /
Have keys been returned? YES NO If yes when & where
Is there any property left by Tenant YES NO

If “YES” Authority to Dispose of Propertysection of this form must be completed.

Has a final reading for Gas/Electricity/Water/Telephone been arranged?

Yes / No / Not Applicable

Note:Do not arrange disconnection.

Has Centrepay deduction been cancelled YES NO CRN
(Centrelink number)
Forwarding Address:
Exit To:
Public Housing: / Seg 1 / Seg 2 / Seg 3
Private / Transfer To WAYSS THM / Abandoned
RTT Action / Returned To Home / Other
Signed by Support Worker: / Date: / / /
PUBLISH / FV / EXEMPT
Housing Type Immediately After Assistance
Improvised dwelling/car/tent/squat / Hospital
Street/park/in the open / Psychiatric institution
House or flat / Prison/youth training centre
Caravan / Other institutional setting
Boarding/rooming house / Client left without providing information
Hostel/hotel/motel / Don’t know
Reason For Ending Accommodation
Tenant moved into other accommodation / Tenant in correctional institution
Tenant evicted because of arrears / Don’t know/accommodation found abandoned
Tenant evicted due to other breach of agreement.
Tenant deceased / Other – please specify
Tenure Type Immediately After Exit
Crisis accommodation (SAAP/THM) / Purchasing/purchased own home
Transitional housing (THM) / Private rental
Other homelessness funded / Public housing rental
accommodation (including short-term / Community housing rental (non THM)
emergency accommodation) / Rent-free accommodation
Institutional setting / Boarding
Improvised dwelling/sleeping rough / Client left without providing information
Other (no tenure) please specify / Don’t know

This Section for Tenancy Administration Use

Rent Card No. / $ / per fortnight.
Utilities Included / YES NO / $ / per fortnight.
Duration of Tenancy
Amount to Pay / $ / Total Paid / $
Amount Outstanding / $ / Debit / Credit
Centrepay Deduction Cancelled / YES NO / Date / //
Keys Returned / YES NO / Date: / //
Locks Changed / YES NO / Date: / //
Exit Inspection/Condition Report / Date: / //
Maintenance follow up required? / YES NO
Cleaning Required? / YES NO
Staff Member / DateExited PAMS / //

Authority to Dispose of Property

I …………………………………, previously a resident of ………………………………..

…...... hereby give my permission to WAYSS Ltd, to dispose of property no longer required by myself.

PLEASE NOTE: Tenants or residents who leave goods behind in the property when they vacate should make arrangements with Property Services (WAYSS) to collect them within 7 days of vacating the property, if goods are still required by the tenant. If contact is not made with Property Services (WAYSS) within this 7 day period, it will be assumed that the goods are no longer required.

After that period Property Services will make a request to Consumer Affairs Victoria to conduct an inspection of the goods left behind with the view of disposing of the goods.

Please tick applicable box

All of the property left. Only the property listed below.

Property
1 / 2
3 / 4
5 / 6
7 / 8
9 / 10
11 / 12
13 / 14
15 / 16
17 / 18
19 / 20
Signed: / Name / Signature
Witness: / Name / Signature
Date: / / /

If you are entitled to any rent refund at the conclusion of your tenancy, this will be deposited into your bank account.

Please complete the details below.

I______previously of ______

give permission for WAYSS to refund my rent credit into the below bank account.

Financial Institution
Account Name
BSB
Account Number
Signed
Date
Witness
Name
Signed
Date
Doc No:9
Version:16 Issue Date: 19/01/2015 / Author: CPS
Authoriser: MPS / Approved by: GMQA
UncontrolledCopy When Printed / Page 1 of 4