Landlord Deposit Bond Claim Form

LANDLORD DEPOSIT BOND CLAIM FORM
Please be advised that any claim will only be considered up to the value of the Deposit Bond. The amount of the Deposit Bond is clearly stated on the Deposit Bond certificate issued. The Council will never make a payment for more than the value of the Deposit Bond. Any claim must be submitted within 4 weeks of the tenancy end date.
Landlord / Agent Details
Name of Landlord

First NameLast Name
Agent Name
Address of Landlord / Agent

House name / number

Street Address

TownState / Province

Post Code
Email address
example@example.com
Phone Number (this must be provided)*
Please enter a valid phone number.

Tenant(s) Details
Name of Tenant (this must be completed)*

PrefixFirst NameLast Name
Name of Tenant (optional - only if more than one tenant)

PrefixFirst NameLast Name
Property Address (this must be completed)*

House name / number

Street Address

TownState / Province

Post Code
Tenant's Email address
example@example.com
Tenant's Phone Number
Please enter a valid phone number.
Forwarding Address

House name / number

Street Address

TownState / Province

Post Code
Tenancy Start Date

DayMonthYear
Tenancy End Date

DayMonthYear
Reason Tenancy ended (this must be completed)*
Deposit Bond Amount
Additional Deposit Amount
Has the additional deposit amount been used to recover any costs?

YesNo

Claim Details

Details of any loss / damage
Evidence must be provided for each individual item being claimed for. This will then be compared to the inventory provided at the start of the tenancy. Claims for items considered as reasonable wear and tear during the course of the tenancy will not be granted.
Please provide details of loss / damage here
Rent Arrears
Please provide evidence of any rent arrears e.g. rent account statement, bank statements etc
Date Rent Arrears started

DayMonthYear
Please upload evidence as appropriate

Cancelof

LANDLORD DEPOSIT BOND CLAIM FORM