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Fillable Printable House Rent Allowance Application Form

Fillable Printable House Rent Allowance Application Form

House Rent Allowance Application Form

House Rent Allowance Application Form

_________________________________________________________________________
HOUSING ALLOWANCE APPLICATION FORM FOR TENANTS
INSTRUCTIONS
1 Employees who are/became tenants on or after 1 January 2005 shou ld complete this appli cation form.
2 Complete and tick the boxes that apply to you.
3 Please see the l ist of ducuments in Section B, which must be atta ched to your applica t ion. If necessary please
refer to the Employee Guide on th e Housing Allowance for physical examples.
4 Ensure that you have completed and signed the form and attached all the documents required since lacking
information may delay the payment of your application.
5 If you experience difficulty to complete this application form, please do not hesitate to contact your personnel
office for assistance.
SECTION A: PERSONAL DET AILS
EMPLOYEE’S DETAILS
Surname Initials
Department Component
ID No
PERSAL No
Contact No Work
Home
Cell
SPOUSE’S DETAILS
Surname Initials
ID No
Employer
Work address
Work
Home
Contact No
Cell
SECTION B: RENT AL STATUS
For Official
Use
Tick the
applicable
box if
proof is
attached
Proof is
attached
Reference
code
I am a tenant
because -
Tick the
applicable
box
Proof to be attached
to this application
form
Yes No Yes No
R1 I pay occupational rent
to the person I am
buying my home from
Offer to purchase/
Deed of Sale which
includes the
occupational rent
clause
R2 I rent a home from a
private landlord/
municipality
Rental Agreement
R3 I rent a home from
family or friends
Rental Agreement
R4 I am obliged to occupy
and rent State Housing
as defined in Part XVI
of Annexure B to
PSCBC Res. 3 of 1999
Rental Agreement
R5 I am voluntary
occupying and renting
Other Housing in terms
of a departmental
policy defined in Part
XVI of Annexure B to
PSCBC Res. 3 of 1999
Rental Agreement
SECTION D: OCCUPANCY DETAILS
For Official
Use
Tick the
applicable
box if
proof is
attached
Proof is
attached
The home is occupied by - Tick the
applicable
box
Proof to be attached
to this application
form
Yes No Yes No
Myself
My spouse
My dependants
My spouse and dependants
A sworn affadavit
Date of Occupancy
The full residential address of the home is:
SECTION E: CONFIRMATION, ACKNOWLEDGEMENT, UNDERTAKING AND DECLARATION
I the undersigned,
(a) Confirm that the information in this application form is accurate.
(b) Acknowledge that I could be disqualified from the Home Allowance Scheme should the information provided be false
and/or inaccurate in which event the employer may recover any monies over paid and institute disciplinary action
and/or lay criminal charges (depending on the seriousness of the situation).
(c) Undertake to inform the employer should there be any changes in my situation as a home owner and occupancy of my
home; and
(d) Declare that the home is occupied as indicated in the form.
________________________________ ______________________________________
Employee Signature Date
FOR OFFICE USE ONLY
Employee Persal No
Employee is a tenant in category R1 R2 R3 R4 R5 Do not
comply
The home is occupied according to the
requirements in the Determination on Housing
Yes No Do not
comply
Application for Housing Allowance is –
Approved
PERSAL Code assigned
(tick the applicable code)
Corresponding
Reference Code in Section
B
0547 Rental (R1 – R5)
OR
Declined
Reasons (if declined)
Signature of official
authorised to
aproved the Housing
Allowance
Name in print
Designation
Date
INSTRUCTIONS
Prepare decline letter with reasons
Inform employee of the outcome of his/her
application
Prepare letter of approval
Capture on PERSAL
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