Relinquishment of Tenancy Consent

DCJ3006

This form is to be completed and signed by the tenant. Giving consent to relinquish your tenancy means that you agree to end your tenancy agreement with the NSW Land and Housing Corporation (the landlord), the Minister administering the Housing Act 2001 (the landlord) or the Aboriginal Housing Office (the landlord).

Information for the Tenant:

Disposal of goods and any cost recovery will occur in accordance with relevant legislation (e.g. the Uncollected Goods Act 1995 (NSW), where applicable.

T-File

Client Reference Number

Tenancy Details

Title

Last name or family name

Given name (s)

Email *

Contact Number

Property Address

Street address

City

State

Postcode

Termination and Possession

I agree that:

1. The residential tenancy agreement for the property listed above is terminated on:

Date: *(this must be a Sunday)

By: *(name of tenant or executor of their estate)

2. Possession will be given to the landlord on:

Date(keys are to be returned on or before this date)

3. Tenant Instructions

(please select one)

Options

I consent to Homes NSW disposing of any goods left at the property.I have organised for a third party to collect my belongings within 14 days of this notification.

Name of Third Party

Phone

Email

I have boooked a council collection for

Date

4. Disposal and Costs

I understand that disposal of goods left at the property may incur costs. *

I understand the costs I can be charged for, include removal and disposal costs. *

I understand costs will be calculated in accordance with law and may be recoverable as a debt. *

I agree that I will be liable for disposal costs (subject to law) whether disposal occurs immediately by consent or after the 14‑day period. *

Forwarding Address

Street address

City

State

Postcode

Signature of Tenant / Executor / Guardian

I am the tenant or executioner of the estate

I am a legally appointed Guardian of the tenant

I understand that by signing this form I am giving consent for Homes NSW to dispose of my goods and that I may be charged for the reasonable costs of storage and disposal in accordance with the law.

Full name of tenant or executor of their estate *

Tenant or executor of their estate's signature *

Draw signature|Type signatureClear

Date *

If signing on behalf of the tenant as their legally appointed guardian, such as the NSW Trustee and Guardian or private enduring guardian, sign here.

Full name of legally appointed guardian *

Legally appointed guardian's signature *

Draw signature|Type signatureClear

Date *