APPLICATION FORM FOR HOUSING ASSISTANCE FOR FIRE VICTIMS

Total Annual Household Income

Type of tenure

Bank Account details

I Confirm that

I Attach

* All attachment to be PDF format and one page attachment

* Documents to support income of each household member      above 18 years and attached separately

Terms and Condition:

I intend to avail the housing assistance towards the repair of my residential property that was destroyed by Fire.

I understand that a false declaration on this form will invalidate my application and may result in further legal action being taken against me.