Rental Bond Refund Sample Form
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Bond refund form
1. Fill out this form to request a bond refund.
2. Please read the important information on the back of this form before entering any details.
3. ALL sections of this form must be completed.
4. If you have a separate tenancy agreement for a room in the property, please supply the room number.
5. Use black or dark blue pen.
Property ID:
Landlord refund details
Print your full name(s) below
Name(s)
Address of the rented property
3
Bond number
1
4
Refund details
Pay the landlord(s) $
Pay the tenant(s) $
Hold in dispute $
TOTAL $
Landlord's reason for claiming some or all of the bond (tick boxes)
Please initial (countersign) any alterations you make or your refund may be delayed.
Arrears Repairs Cleaning Outgoings Other
Bank account number
(Only complete if you are claiming money)
If you have provided us with your e-mail address, we will send you an email
once the refund is processed
.
Your reference (to appear on your bank statement)
Tenant refund details
Print your full name(s) below
Name(s)
Bank account number
(Only complete if you are claiming money). Please indicate how much each tenant receives
Signatures
All landlords and tenants must sign below and agree that the information provided on this form is true and correct.
Landlord(s) signature(s):
Date:
Date:
Tenant(s) signature(s):
2
Date tenancy ended
Address for Service (An Address for Service is explained on the back of this form.)
Address for Service (An Address for Service is explained on the back of this form.)
Receives: $Name:
Receives: $Name:
Receives: $Name:
Receives: $Name:
Street
name
Town/
City
Street
no.
Room
no.
Suburb
Property/
Building name
Unit/
Flat no.
Rural
delivery no.
Unit/Flat
no.
Suburb
PO Box/
Private Bag
Email
Daytime
phone no.
( )
Fax
( )
Mobile
Postcode
Street
name
Town/
City
Street no.
Rural
delivery no.
Landlord ID Number
Unit/Flat
no.
Suburb
PO Box/
Private Bag
Email
Daytime
phone no.
( )
Fax
( )
Mobile
Postcode
Street
name
Town/
City
Street no.
Rural
delivery no.
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Rental Bond Refund Sample Form PDF
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