Fillable Printable 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).

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

0547 Rental (R1 – R5)

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