Application No. 
	Transfer application 
	pursuant to the Housing Act 2003.

Transfer Application

Social housing transfers are available to help Queenslanders with their housing needs. This application collects essential information to assess eligibility for transfer to alternative accommodation. Submission of this application does not guarantee an offer for transfer.

Important information
Your eligibility for a transfer will be assessed based on the information and the supporting documentation you provide with this application. If your circumstances change at any time, please notify your local Housing Service Centre within 28 days of the changes.

Completing this application – have you:
Answered all the questions with a tick where there are       Yes/No boxes?
Collected evidence and supporting documentation including proof of income and assets for new household member/s in this application?
Read and signed the declaration and consent on the last page?
Had this application signed by a witness on the last page?
Alternatively, Housing Service Centre officers can witness this application if you are submitting it in person.
Got identification ready of new household member/s for when you submit this application?
Alternatively, you can attach witnessed copies of identification evidence if you are returning this application via post.

For more information on housing assistance, please call or visit your local Housing Service Centre. Alternatively, you can access information at www.qld.gov.au/housing or download our ‘Housing Assist Qld’ mobile app from the Google Play, Microsoft or Apple App stores.

For office use only	
This application is not required to be completed if transfer is due to portfolio management reasons.	

Application Assistance
What is your first spoken language?
Do you need an interpreter? If you speak in a language other than English, or have hearing difficulties, we can arrange for an interpreter to assist you.
Which interpreter do you require?           Language, provide details:
                                                                Signing
Do you need assistance when

This may be a person that helps you to make decisions, or someone who makes decisions on your behalf about your personal, lifestyle or financial matters.

making decisions?                                Yes           No
                                                         If yes, which of the following.

                                                                 Public Trustee                                         Family, Friend or Advocate

                                                                 Office of the Public Guardian                  Power of Attorney
                                                                 Other, provide details:
Tenant Details
Full name/s:
Address:
Telephone:           Home:                                                              Mobile: 
            Work:
Email:
Tenancy reference number:
Centrelink reference number (CRN):

Tick all that apply.

   

Type of transfer?               Social Housing             Mutual exchange

Reason for transfer? 

Who are the current household
members and their date of birth?

Will everybody listed on your
current tenancy agreement
be transferring with you?                  Yes           No
                                                      If no, who will not transfer to the new tenancy?

Note: No person can remain at the property once transfer is complete.

Is any household member
expecting a child?                              Yes           No
                                                      If yes, expected due date:

  0

What type of transport do
you use?                                             Public            Own            Other (family and friends)

Note: If more than four household members, complete and attach ‘Additional household member’ forms before submitting this application.

New household member details
What is your relationship with the tenant/s? 
Full name:

Any other name you may be known as.

Alias: 

Gender:                                Date of birth:           /         /               Country of birth:

  0   

Tick all that apply.

Do you identify as:           Aboriginal                                Australian South Sea Islander
                                           Torres Strait Islander              Other cultural or linguistic background             None
Centrelink reference number (CRN):
Department of Veteran Affairs reference number (DVA):
Citizenship/Residency details:         Australian citizen                    Permanent resident
                                                             Not permanent resident         Visa - what type?
Are you expecting a child?               Yes           No
                                                      If yes, expected due date:
Do you have a medical
condition or disability?                      Yes           No
                                                      If yes, provide details:

Gross amount and type (wages, pension, allowances, family payments, interest, superannuation).

What is your income?              $                       Frequency:                        Type:
                                                   $                       Frequency:                        Type:

Savings, investments, cash deposits, property trusts, shares, bonds, debentures, superannuation - allocated pension or lump sum payments, share from property sale or settlement.

What are your assets?             $                       Type:
                                                   $                        Type:

Do you own/part own property

This could include residential, vacant land, industrial property, commercial property, live-aboard boat, cabin, donga, caravan, or manufactured/ transportable home.

in Australia or overseas?                 Yes            No
                                                      If yes, what type:
                                                      Address:
                                                                          % of property owned:
                                                                       Current property value:
                                                                                  Ownership date:
What type of transport do 

  0

you use?                                             Public            Own            Other (family and friends)

Your need to transfer

Tick all that apply.

Does your household need to transfer for any of the following reasons?

   

	You are experiencing or at risk of domestic and family violence	

	You are experiencing family or relationship breakdown	

	Your housing has been impacted by a natural disaster	

	You are experiencing or at risk of violence, abuse or harassment from a household or community member	

	You need to meet your or a household member’s disability support needs	

	You are a victim of major crime that was committed in Queensland	

	

You have the safety of a child in your care at risk		You have a history of homelessness			

Tick all that apply.

Is your current housing location unsuitable for any of the following reasons?

   

	Too close in proximity to the perpetrator of domestic violence against you	

	Distance does not allow you to accept a firm offer of employment – minimum 20 hours per week	

	Does not enable you to gain or maintain regular access or custody to shared care of children	

	Does not meet the conditions of a Court Order, Parole or Probation Order, Family Court Order, Domestic Violence Order, Child Protection Order	

	Too far away from frequently required essential services – transport, medical, disability support for daily activities, transport to meet mobility requirements	

 

	You wish to enable family reunification	

	Too far away from family and community support which impacts on the wellbeing of the household	

	Too far away from education or training services		You are an Aboriginal or Torres Strait Islander person and need to move for cultural reasons	

Tick all that apply.

Is your current housing unsuitable for any of the following reasons?

   

	Design restricts daily living activities – bathing, mobility, or seriously aggravates a medical condition or disability	

	Size too small resulting in overcrowding			

Your financial wellbeing

Tick all that apply.

Are you or another tenant experiencing any of the following situations?

   

	Unable to work and have high levels of living expenses beyond normal living costs related to a long-term or serious medical condition or permanent and/or significant disability	

 

	Multiple periods of unemployment 
Long-term unemployment	

	Currently employed –

Part-time

Full-time

Casual	

Your wellbeing

Tick all that apply.

Have any of the following affected you or your household’s ability to access stable housing?

   

	You or a household member have a permanent and significant disability	

	You are experiencing or at risk of violence, abuse or harassment from another person or community member	

	A limited number of or no suitable properties to meet needs - size, location or features	

	You or a household member have a long-term or serious medical condition	

	

You are a young person at risk who requires a tailored response on your path to independence	

	Your safety is at risk
History of homelessness	

Your future housing

You may be offered housing from any of the areas listed below.

Where do you want to live?

Area 1:		Area 4:		
Area 2:		Area 5:		
Area 3:		Area 6:		

More than one housing type can be applied for. We will make every effort to offer the type of housing that you have chosen and are eligible for. However, this cannot be guaranteed. Housing with four or more bedrooms are limited.

What types of housing do you want to apply for?

   

 

Townhouses have three or more units next to each other with one to four bedrooms each, divided by common walls. These can be single or double storey and usually have small fenced yards.		Cluster housing is several separate homes with two to four bedrooms each, located within a housing development.	

	Apartments/flats/units are usually a complex of two or more storeys, may be studio style or have up to three bedrooms. These do not have a separate yard.	

	Seniors’ units are only available to applicants over 55 years of age and are usually in a complex of one or two storeys with one to two bedrooms.	

	Detached houses are one house with two or more bedrooms on its own block of land.

		Dual Occupancy are two detached houses that are on one block of land, sometimes with a shared driveway.	

	Duplexes are usually two units with one to three bedrooms, each on a block of land, divided by a common wall. These may be in groups of two to four.			
Do you need disability housing
features for your home?                       Yes           No
                                                          If yes, provide details:
Will you accept housing with

Living, bathroom or kitchen facilities may be shared. If you accept an offer, you can choose to remain on the Housing Register for housing which has its own facilities.

shared facilities?                                   Yes           No

Does the household have pets?          Yes           No

                                                          If yes, provide details:

Attach a page if necessary.

Additional information you would like to provide?

Evidence for your application

All evidence to support your application must be provided before it can be completely assessed. Please tick all that apply.

What identification evidence can new household member/s provide?

	Primary		Secondary	

 

 

Australian Birth Certificate or extract		Bank, credit or ATM card with your signature	

	Australian Naturalisation or Citizenship Certificate	

	Bank, credit union or building society statements	

Australian Permanent Residency Certificate or stamp		Centrelink correspondence with CRN	

	Immicard, Immigration or sponsorship papers	

	Medicare Card	

	Temporary Protection Visa or stamp	

	Health Care Card	

	Australian Passport	

	Seniors/Pensioner Card	

Australian Driver licence	

	Taxation Assessment Notice	

	Photograph identification car

d (Queensland Transport)		Australian Marriage Certificate	

	Adult Proof of Age Card until expiry (Queensland Transport)	

	Australian divorce papers	

	18+ card until expiry (Queensland Transport)	

	Life Insurance policies	

	Keypass Card	

	Other photographic identification such as
security identification, cash converters card	

	Queensland Corrective Services verification			

Below are examples of other types of evidence new household members will need to provide, where applicable. Existing household members must also provide up-to-date income, assets and property ownership evidence as detailed below.

Further evidence required

•	Decision-making – Public Trustee, Guardian, Power of Attorney documentation
•	Income – Centrelink income statements, payslips, employer’s declaration/s
	Household members over 16 years receiving Centrelink payments can give consent to the department to obtain income and assets details electronically from Centrelink.
•	Assets – quarterly bank statements and documentation showing details of other assets and their current valuation
•	Property ownership – title deed, mortgage documents, contract of sale
•	Your need to move – documentation supporting reasons for having to move
•	Medical or disability – completed ‘Medical Report’ form (PH068)
•	Your wellbeing – completed ‘Support Statement’ form (PH076)

Note: Some income, medical and referral forms are available at www.qld.gov.au/housing. Alternatively, visit your local Housing Service Centre for forms or advice.

All evidence to support your application must be provided 
before an assessment can be completed.

Declaration and consent
Personal Information Privacy Notice
The Department of Communities, Housing and Digital Economy is collecting personal information on this form to provide you with housing assistance or assess grant funding applications. This is authorised by the Housing Act 2003. To assist you with your housing needs and services, relevant personal information may, in very limited and specific circumstances, be disclosed to: partner agencies, service providers, agencies authorised by legislative provisions, and local governments and non-governmental agencies that now, or will provide you with housing and/or support services. Limited personal information may be used for housing related research, policy or planning functions. Unless authorised or required by law, your personal information will not be passed on to any other third party without your consent. More information about the department’s privacy policy is available on our website at www.chde.qld.gov.au.

I understand:
•	the instructions given on this form and agree to the Privacy Notice above
•	the information on this form will be used by the Department of Communities, Housing and Digital Economy to register my application for a transfer, providing I am eligible
•	my personal information may be given to government and non-government organisations to provide me with housing and/or support services
•	as tenant/s, I must advise the department if any circumstances change regarding current or new household members that is relevant to this application
•	that I may become ineligible for housing assistance if changes occur to my or my household’s circumstances, incomes and/or assets
•	upon submitting this application, new household member/s must provide at least one item from the primary and secondary identification evidence list above as proof of identity. One of which, for each new household member, must show a Queensland address, signature and date of birth.

To the best of my knowledge, the information provided on and in conjunction with this application is true and correct. I understand that I will commit an offence and be liable to a penalty under the Housing Act 2003 if I knowingly provide to the Department of Communities, Housing and Digital Economy false or misleading information that may influence decisions about my eligibility for housing assistance and may make my application invalid.

Applicant name:                                                             Applicant name:
               Signed:                                            /     /                         Signed:                                           /     /

      Date:		     Date:

I am a Department of Communities, Housing and Digital Economy employee / registered community housing provider employee / Corrective Services officer / Justice of the Peace / Commissioner for Declarations / Solicitor.
I have witnessed the above signatures and sighted two of the listed identification evidence items for each applicant.

 Witness name:                                                          Position:
             Signed:                                           /     /        Organisation: