Fillable Printable Rental Bond Refund Sample Form
Fillable Printable Rental Bond Refund Sample Form
Rental Bond Refund Sample Form
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Bond refund form
1. Fill out this form to request a bond refund.
2. Please read the important information on the back of this form before entering any details.
3. ALL sections of this form must be completed.
4. If you have a separate tenancy agreement for a room in the property, please supply the room number.
5. Use black or dark blue pen.
Property ID:
Landlord refund details
Print your full name(s) below
Name(s)
Address of the rented property
3
Bond number
1
4
Refund details
Pay the landlord(s) $
Pay the tenant(s) $
Hold in dispute $
TOTAL $
Landlord's reason for claiming some or all of the bond (tick boxes)
Please initial (countersign) any alterations you make or your refund may be delayed.
Arrears Repairs Cleaning Outgoings Other
Bank account number
(Only complete if you are claiming money)
If you have provided us with your e-mail address, we will send you an email
once the refund is processed
.
Your reference (to appear on your bank statement)
Tenant refund details
Print your full name(s) below
Name(s)
Bank account number
(Only complete if you are claiming money). Please indicate how much each tenant receives
Signatures
All landlords and tenants must sign below and agree that the information provided on this form is true and correct.
Landlord(s) signature(s):
Date:
Date:
Tenant(s) signature(s):
2
Date tenancy ended
Address for Service (An Address for Service is explained on the back of this form.)
Address for Service (An Address for Service is explained on the back of this form.)
Receives: $Name:
Receives: $Name:
Receives: $Name:
Receives: $Name:
Street
name
Town/
City
Street
no.
Room
no.
Suburb
Property/
Building name
Unit/
Flat no.
Rural
delivery no.
Unit/Flat
no.
Suburb
PO Box/
Private Bag
Email
Daytime
phone no.
( )
Fax
( )
Mobile
Postcode
Street
name
Town/
City
Street no.
Rural
delivery no.
Landlord ID Number
Unit/Flat
no.
Suburb
PO Box/
Private Bag
Email
Daytime
phone no.
( )
Fax
( )
Mobile
Postcode
Street
name
Town/
City
Street no.
Rural
delivery no.
• Please use a black or dark blue pen.
• Print clearly.
• Make sure you write in all the boxes that apply to you. If you
don’t, there may be a delay in processing the bond money.
• Call us if you need help – it’s free – on 0800 737 666.
Below is an explanation of each section of the form. The number of each
section is next to the explanation.
1 Address of the rented property
This number is on all our letters to you about this rented property. If you
do not have it, please call us.
2 Landlord etails
It is important that you include the date the tenancy finished, as agreed
between the tenant and the landlord. This date can affect the way the
bond is finally paid out.
.
Property ID number – If you do not know the Property ID number for
this property, leave the box blank, or call us to find out the number.
This individual number for the property helps us to be more accurate
throughout the bond lodgement and refund process.4
This section shows how you have agreed the bond money will be paid out
to the tenant, landlord or both.
If the landlord wishes to claim some or all of the bond money, they must
indicate the reason why using the tick-boxes.
If there is any amount that you cannot agree on, this should be written in
under ‘Hold in Dispute’. This amount will not be paid out until agreement
is reached or until a mediated/Tenancy Tribunal order is made.
The landlord(s) should complete this section.
This information will assist Tenancy Services to contact you about this
bond and to minimise any delays in paying out/refunding the bond.
Landlord ID number – If you do not know the Landlord ID number for
this landlord, leave the box blank, or call us to find out the number.
This individual number for the landlord helps us to ensure accuracy
throughout the bond lodgement process.
Bank account number – only give us your bank account number if you
are to be paid some of the bond money.
PLEASE NOTE: All landlord details provided to Tenancy Services for this
bond (including the Address for Service) will be used as the most current
address for all that landlord’s properties and bonds.
Address for Service
The Address for Service must be a street address in New Zealand where
notices and other documents relating to the tenancy will be accepted by
you, or on your behalf, even after the tenancy has ended.
In addition to a street address, a PO Box, fax number, or email address can
also be provided to be used as an Address for Service also.
PLEASE NOTE: By providing a PO Box, fax number, or email address, you
are authorising Tenancy Services to use these to contact you.
The tenant(s) should complete this section.
This information will assist Tenancy Services to contact you about this
bond and to minimise any delays in paying out/refunding the bond when
the tenancy finishes.
Bank account number – only give us your bank account number if you
are to be paid some of the bond money.
Other information about bonds
2
Date tenancy ended
3
Address of the rented property
4
Refund details
5
Landlord refund details
6
Tenant refund details
Bond number
1
If all tenants do not sign this form and indicate how much each tenant is
to receive, Tenancy Services will be unable to release the bond until all
tenant signatures are obtained.
Address for Service
The Address for Service must be a street address in New Zealand
where notices and other documents relating to the tenancy will be
accepted by you, or on your behalf, even after the tenancy has ended.
In addition to a street address, a PO Box, fax number, or email address
can also be provided to be used as an Address for Service also.
PLEASE NOTE: By providing a PO Box, fax number, or email address,
you are authorising Tenancy Services to use these to contact you.
These signatures are important because they will be matched with the
signatures on the Bond lodgement form that you filled out at the
start of the tenancy. If they are not the same, then any refund you have
requested may be delayed.
If preferred, the tenant can transfer the existing bond to their new
address instead of having the bond refunded into their bank account.
To transfer a bond
When a tenant who has paid a bond moves to another rented property,
the bond can be transferred to the new address. You need to send a
Bond transfer form to Tenancy Services signed by:
• The tenant(s)
• The previous landlord/agent(s)
• The new landlord/agent(s)
Your personal information
Information provided on this form will be held and used by the Ministry
of Business, Innovation and Employment for the purposes of
administering the Residential Tenancies Act 1986.
This information you supply may also be used for carrying out customer
surveys, public education and statistical analysis. We may occasionally
provide your information to third parties to carry out this work on our
behalf or where it is required by the law. When providing your information
to third parties, we will take all reasonable steps to ensure that they do not
use your information for any reason other than the intended purpose.
The information you supply will be provided to all parties named in your form.
You can access or correct your personal information held by us at any time.
Please be aware that a failure to provide the information requested may result
in a delay in the processing of the bond.
Any questions?
If you have any questions about this form or need more information
about bonds, please freephone 0800 737 666, fax (04) 237 7884 or
write to us at PO Box 50445, Porirua 5240.
Ki te mea he p
-
atai
-
au m
-
o t
-
enei puka, kei te p
-
irangi p
-
arongo r
-
anei m
-
o te
moni here (bond), waea koreutu 0800 737 666, waea whakaahua
(04) 237 7884, tuhituhi mai r
-
anei ki a m
-
atou i Pouaka Pout
-
apeta 50445,
Porirua 5240.
’A iai ni fesili e uiga i lenei pepa pe mana’omia fo’i nisi fa’amatalaga e uiga
i le tupe fa’amau (bond), fa’amolemole telefoni mai i le numera
0800 737 666, fax (04) 237 7884 pe tusi mai fo’i ’ia ’i matou i le Pusa
Meli Numera (PO Box) 50445, Porirua 5240.
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Tenant refund details (continued)
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Signatures
Other help
All our forms and other information are on our website at:
www.tenancy.govt.nz
If you have questions at any time about your rights and obligations
when renting call our tenancy advice freephone:
0800 TENANCY (0800 83 62 62).
Before you send in your form CHECK:
Has everyone signed the form?
Is there an Address for Service for the landlord(s) and tenant(s)?
Are all the $ boxes filled in correctly?
This information will help you fill out your form.
Please read it BEFORE you write on the form.
How to fill out this form
