Joint Application for Disposal of Security Bond

Bond Administrator 219 St Georges Terrace Perth WA 6000 Refunds available in person 9 am to 4.30 pm; Mon - Fri PLEASE PRINT CLEARLY USING BLUE PEN Postal Address: Bond Administrator Locked Bag 14 Cloisters Square WA 6850

Government of Western Australia

Department of Commerce Consumer Protection

Form 4 - Residential Tenancies Act 1987 Schedule1, Clause 5(1)(a), 7(1)(a) & 7(3)(a). - Residential Parks (Long-stay Tenants) Act 2006 Section 92(e) & 94(c)
Advice Line: 1300 30 40 54 Web: www.commerce.wa.gov.au

RENTAL BOND REFERENCE No.

/
Postcode Tenancy end date

Address of rental premises (USE BLOCK LETTERS)

/
Tenant(s)
Name of tenant 1

/ /

(all tenants must sign - all signatures must match those currently held by the Bond Administrator)
Day Time Phone No (Must be completed) Account no Branch Name of account holder Postcode
Amount to be paid to tenant 1

Date Signature

New postal address BSB no

$
Do not sign a blank form
Name of Australian bank/building society/credit union

Name of tenant 2

Day Time Phone No (Must be completed) Account no Branch Postcode

Amount to be paid to tenant 2

Date Signature

New postal address BSB no

$
Do not sign a blank form
Name of account holder Name of Australian bank/building society/credit union

Name of tenant 3

Day Time Phone No (Must be completed) Account no Branch Postcode

Amount to be paid to tenant 3

Date Signature

New postal address BSB no

$
Do not sign a blank form
Name of account holder Name of Australian bank/building society/credit union

Amount to be paid to Dept. of Housing (Homeswest) Transfer to New Lodgement Owner(s)/Agent/Park Operator
Name of owner(s)/agent/park operator 1. 2.

$ $
Please attach new lodgement form

Phone No

Amount to be paid to owner(s)/agent/ park operator

Date Signature

Address BSB no Account no

Fax No

$
Name of Australian bank/building society/credit union Branch Name of account holder

Total Bond $
Important - Do not sign this form until you have read the information on the reverse of the form.

Office use only

checked

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IMPORTANT INFORMATION FOR DISPOSAL OF SECURITY BOND MONEY SIGNING THE FORM Do not sign this form until the tenancy has ended and payment sections of this form have been completed. If you are a tenant do not sign this form unless you agree that the amount of the security bond should be disposed of to the parties and in the amounts as completed on this form. For residential tenancies, if you cannot agree on the amounts payable you may need to make an application to a Magistrates Court for a determination on how the security bond is to be disposed of. For long-stay park tenancies, if you cannot agree on the amounts payable you may need to make an application to the State Administrative Tribunal for a determination on how the security bond is to be disposed of. CHANGES TO THE FORM Any change to this form must be veried by the full signature of each party to the residential tenancy agreement or long-stay agreement. PAYMENT OF THE SECURITY BOND Cheques will be drawn or direct deposits paid in the amount/s and to the account/s in accordance with this application. If tenants require separate cheques or direct deposits, written authority (by completing the Tenant(s) section on the front of this form) must be received from each tenant stating the amount that each tenant is to receive. The New postal address area for each tenant must be completed to allow payment by cheque where bank account details are not provided or are incorrect or incomplete. All parties to the residential tenancy agreement or long-stay agreement are required to sign this form, even if some of the parties are not actually receiving any payment. If any party to the residential tenancy agreement or long-stay agreement is not receiving any payment, place $ 0 in the amount to be paid section for that party.

Seek advice immediately if you need more information. For Translating and Interpreting Services please telephone TIS on 13 14 50 and ask to speak to the DEPARTMENT OF COMMERCE (1300 30 40 54) for help and assistance.