Bond Claim Form

1. Property Details

Bond Number: [INSERT BOND NUMBER] Rental Property Address: [INSERT FULL STREET ADDRESS] Suburb: [INSERT SUBURB] State: [INSERT STATE] Postcode: [INSERT POSTCODE] Tenancy Start Date: [DD/MM/YYYY] Tenancy End Date: [DD/MM/YYYY]

2. Landlord/Agent Details

Name: [INSERT FULL LEGAL NAME] Phone Number: [INSERT PHONE NUMBER] Email Address: [INSERT EMAIL ADDRESS] Address for Notices: [INSERT STREET ADDRESS] Account Name for Refund: [INSERT BANK ACCOUNT NAME] BSB: [INSERT BSB] Account Number: [INSERT ACCOUNT NUMBER]

3. Tenant Details

Tenant 1 Name: [INSERT FULL LEGAL NAME] Signature: [SIGN HERE]

Tenant 2 Name: [INSERT FULL LEGAL NAME] Signature: [SIGN HERE]

4. Claim Details

Total Bond Amount Held: $[INSERT TOTAL AMOUNT]

Refund to Tenant

Amount to be paid to Tenant(s): $[INSERT AMOUNT]

Claim by Landlord/Agent

Reason for Claim: [SELECT ONE: UNPAID RENT, DAMAGE, CLEANING, OTHER]

Please itemise your claim below:

Description	Amount ($)	Receipt/Quote Attached?
[e.g. Carpet Cleaning]	$0.00	[Yes/No]
[e.g. Gardening]	$0.00	[Yes/No]
[e.g. Unpaid Rent]	$0.00	[Yes/No]
Total Claimed	$0.00

5. Declaration

Tenant Declaration: I/We agree that the landlord/agent may claim the amount of $[INSERT CLAIM AMOUNT] from the bond. I/We agree that the remaining amount of $[INSERT REFUND AMOUNT] should be paid to the bank account listed above.

Tenant Signature: __________________________ Date: //______

Landlord/Agent Declaration: I/We declare that the information provided in this claim is true and correct. I/We understand that it is an offence to make a false claim.

Landlord/Agent Signature: __________________________ Date: //______