Private Leasing - Interested Party

Private Leasing - Interested Party

DCJ0143

This form is to be completed by the landlord / agent to provide business and bank details so the social housing provider can create a vendor record and process payments.

If you have previously received payments, please contact us to confirm whether an existing vendor record is already in place.

For information or assistance with this form, phone 1800 422 322 24 hours a day, seven days a week.

Email address of the Homes NSW representative you would like to send this form to *

Vendor details

Business /or individual name *

ABN

Business Address *

Street address *

City *

State *

Postcode *

Phone number *

Email address (To send remittance advice) *

Do you wish to be set up for RCTI (recipient created tax invoices)?

Bank details for Electronic Funds Transfer

BSB number *

Account number *

Account name *

Bank / Institution name *

Address of branch

Declaration

I/ We (the Vendor) agree to abide by the following conditions that: In consideration of Homes NSW or the Social Housing Management Transfer community housing provider undertaking to remit all moneys due to the Vendor under any contract from time to time held with Homes NSW or the Social Housing Management Transfer community housing provider as the case may be, within the time for payment specified in any such contract and in accordance with the particulars set out herein or as otherwise notified by the Vendor to Homes NSW or the Social Housing Management Transfer community housing provider in writing, the Vendor agrees that Homes NSW or the Social Housing Management Transfer community housing provider shall not be liable for any loss or damage, whether direct or consequential, arising out of any error,omission or delay on the part of the financial institution to which such moneys are remitted.

I/ We (the Vendor) hereby authorise and direct the relevant authorities to verify details of property ownership to Homes NSW/the Social Housing Management Transfer community housing provider.

This authority and direction is a consent for the purposes of the Housing Act 2001, the Privacy and Personal Protection Act 1998 or the Privacy Act 1988.

I/ We (the Vendor) understand that there are penalties under the Housing Act 2001 for making false statements or representations that assist others to obtain accommodation or other benefits from Homes NSW a Social Housing Management Transfer community housing provider.

Notice: The information provided on this form will be exchanged between Homes NSW and Social Housing Management Transfer community housing providers (public, community and Aboriginal housing) for the purpose of providing paymentfor services under any contract.

I/We (the Vendor) understand the instructions given on this form.
I/We (the Vendor) declare to the best of my knowledge, the information provided in this form is correct.
I/We (the Vendor) understand there are penalties for giving false or misleading information.
I/We (the Vendor) understand that this information is used by Homes NSW and Social Housing Management Transfer community housing providers (public, community and Aboriginal housing).

Full name (please print) *

Signature *

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Date *