Rent Certificate: August

Locked Bag 7834 Canberra BC, ACT 2610 Your Centrelink Reference Number is: 503 191 055B
Return this form by
2019
CLK2SU523 D300Q2U2Y9001
August
28
or your Rent Assistance will stop.
Return address
Miss Stacey Greenwood Reply Paid 7800

25 Sandpiper Ct Canberra BC, ACT 2610
MODBURY HEIGHTS SA 5092
How to return this form

You can submit this form in your Centrelink online
account or the Express Plus Centrelink app.
You can also use the reply paid envelope provided.
Make sure the return address above appears in the
envelope window.
Rent Certificate You MUST return pages 1 and 2.
Honesty Declarations
Your landlord or their
authorised representative
You unless a current lease or
tenancy agreement is attached.
I, Miss Stacey Greenwood I,

(print your full name)
- promise that the information contained in this
- declare that I am a landlord, authorised agent or
Rent Certificate is true, complete and correct.
rent collector.
- understand that intentionally providing false or
- understand that intentionally providing false or
misleading information is a serious offence.
misleading information is a serious offence.
- understand that Centrelink may check information
- verify that Miss Stacey Greenwood lives at:
I provide with other sources.
45 FLOCKHART AVE
Signature VALLEY VIEW SA 5093
- confirm that the total rent at this property is:
$310.00 weekly
Information provided may be verified with the

Australian Taxation Office.
Phone number
( )
Landlord/Authorised Representative address
Postcode
Office Use Only Signature

Tenancy Agreement/Lease sighted and checked
Logon Date \ \
SU523HD.1904 Page 1 of 3
1/1-1
503 191 055B
Your accommodation details
Below is information supplied to us about your accommodation as of 1 July 2019.
Please check to make sure all information is correct. It is important we have your correct rent
details to make sure you are paid the right amount of Rent Assistance.
If all of the information below is correct, follow the instructions on the front page to return this form.
Your address
The address for which you are receiving Rent Assistance is:
45 FLOCKHART AVE, VALLEY VIEW SA 5093
Address type
The above address is your: Home
Home owner status

Your home owner status is: Non-homeowner
Rent type
The type of rent you pay is: Private rent
Rent amount
The amount you pay is: $310.00 weekly
Sharing arrangement
Your sharing arrangement: Does not live in shared accommodation
Includes all family members except children for whom you receive Family Assistance.
Total Rent
The total amount of rent paid for the
property is: $310.00 weekly
Includes the amount you pay and the amount paid by others you share with.
If any of the above is incorrect, you must update your rent details by 28 August 2019
or your Rent Assistance will stop.
The quickest way to update your details is to go online.

Step 1 – Go to my.gov.au and sign in to access your Centrelink online account.
Step 2 – Click 'My profile' and select 'Update address details' or 'Update accommodation details'.
Our service centres have computers available for use if you do not have internet access at home.
If you are unable to go online, call 136 150 or visit a service centre near you.
190808 BCH - L196470Z / L196470Z 2381 BL - 9486
Sign up for myGov and register for a Centrelink online account
If you do not have a myGov account, you can create one at my.gov.au. Once you have created a
myGov account you will be able to register for a Centrelink online account.
For more information, go to humanservices.gov.au/register
Privacy and your personal information

Your personal information is protected by law (including the Privacy Act 1988) and is
collected by the Australian Government Department of Human Services for the assessment
and administration of payments and services. This information is required to process your
application or claim.
Your information may be used by the department, or given to other parties where you have
agreed to that, or where it is required or authorised by law (including for the purpose of
research or conducting investigations).
You can get more information about the way in which the department will manage your
personal information, including our privacy policy, at humanservices.gov.au/privacy
To give us feedback or make a complaint

Go to humanservices.gov.au/feedback to give feedback or call our Customer Relations
Team on 1800 132 468 to make a complaint.
If we do not resolve your complaint to your satisfaction, you can contact the Commonwealth
Ombudsman by going to ombudsman.gov.au
Note: Call charges may apply.
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Locked Bag 7834 Canberra BC, ACT 2610 Your Centrelink Reference Number is: 503 191 055B

Return this form by

Miss Stacey Greenwood Reply Paid 7800

How to return this form

I, Miss Stacey Greenwood I,

Information provided may be verified with the

Office Use Only Signature

Home owner status

The quickest way to update your details is to go online.

For more information, go to humanservices.gov.au/register

Privacy and your personal information

To give us feedback or make a complaint

Note: Call charges may apply.

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