RURAL AND MARITIME HOUSING ASSISTANCE APPLICATION FORM

WARNING: Providing false information to Government is an offence under the False
Information Act 2016. If you are found guilty of providing false information to the Government, you may be fined up to $20,000 or sentence to imprisonment for up to 10 years.

A.     APPLICATION CHECKLIST 

Please ensure that all the following documents are submitted with your application.

Upload of documents

B.     APPLICANT  INFORMATION

Please provide the following details for the main applicant and point of contact for this assistance.

Gender
Social Welfare Recipient

C.     HOUSEHOLD DETAILS

Please provide the details of all members of your household and occupation / weekly income for only those members just above 18.

D.     APPLICANTS CONTRIBUTION

Applicants Contribution:

(Tick one only)

Source of Contribution:

(Tick one only)

Please indicate how you will fund your contribution:

How soon will your contribution be ready for deposit into the government consolidated fund bank account?

Please indicate a potential date after the approval of your application:

E.     APPLICANT DECLARATION