Formal guardian and/or administrator details

	

Use  this  form  to  advise  the  Department  of  Housing  if  you  are  a guardian  and/or  administrator  who  has  been  formally  appointed   by   the   Queensland   Civil   and Administrative  Tribunal  (QCAT) or the former Guardianship and Administration Tribunal  (GAAT).  If  you  need  more  information  or would like to arrange an interpreter, contact your nearest Housing Service Centre.

Client name Client address Phone number
Contact details for formal guardian and/or administrator
Name

Address

Contact numbers

Email

(Business hours)

(After hours)

(Mobile)

How would you prefer to be contacted? (Phone, letter, SMS, email etc). You may list more than one

Description of your guardian/administrator powers as prescribed in your QCAT or GAAT order

Have you attached a copy of your Guardianship/Administration Order issued by QCAT or GAAT?

/	/

/	/

Yes	No	Valid from	(date)	to

Please note: you are not legally required to provide a copy of the QCAT/GAAT order to the Department of Housing. However, should a copy not be provided, the department will not accept directions from you, or provide information to you, in relation to the client.
Privacy Notice The Department of Housing is collecting your personal information so we may provide you with housing assistance. To assist you with your housing needs and services, your personal information may be disclosed to partner agencies, service providers, local governments and non-governmental agencies that now, or will, provide you with housing and/or support services. Unless authorised or required by law, your   personal information will not be disclosed to any other third party without your consent. More information about the  Department’s  privacy obligations is available on our website at www.housing.qld.gov.au.

Signature of guardian and/or administrator
To the best of my knowledge, the information provided on and in conjunction with this form is true and correct. I understand that it is an offence under the Housing Act 2003 to knowingly provide to the Department of Housing false or misleading information that may
influence decisions about the client’s eligibility for housing services.

Name

Signature

/	/

Date

Please return completed form to your nearest Housing Service Centre.

Department of Housing
www.housing.qld.gov.au	PH005-1 (27/07/2023)