Application for Mutual Exchange

Complete this form to request approval to swap homes with another Department of Housing tenant. Your application will be assessed against the department’s mutual exchange eligibility criteria. If approved, you must agree to accept the new property in its current condition.

	
	Postcode		
	
	Postcode		

Tenancy details Tenancy reference No. Current address:

Address you wish to move to

Household details Please attach additional pages if there is insufficient space. Current evidence of income is required for all household members.
All household members names
(including legal tenants and children)	
Relationship to tenant
(eg wife, son, friend etc)	
Date of Birth	Income Type
(e.g. Centrelink, wages etc)	
Weekly Income $	

					

					

Please supply evidence of all household income

Property ownership - do you or any household member own or part own:
a residential property or	Yes	No
vacant land	Yes	No
a caravan or mobile home or live-aboard boat	Yes	No
commercial / industrial property	Yes	No

Australian citizenship or residency (please tick () appropriate boxes)
are you an Australian citizen/s or	Yes	No
are you a permanent resident/s of Australia or	Yes	No
are you a New Zealand citizen who arrived in Australia before 27 Feb 2001 or	Yes	No
do you hold a Temporary Protection Visa (TPV) or	Yes	No
do you hold a Bridging Visa and have applied for a Resolution of Status Visa or	Yes	No
do you hold a Bridging Visa and have applied for a permanent Protection Visa or	Yes	No

Department of Housing
www.housing.qld.gov.au
PH030 (28/07/2023)

Liquid assets

$

	

Please state the total household value of the following assets and provide appropriate evidence. Superannuation (if you have reached preservation age)

$

$

$

	

	

Balance of bank account (e.g. bank, building society, credit union, interest free accounts) Deposits (interest bearing, fixed)

Share from a property settlement Property trusts
Bonds
Managed investments

Share from the sale of a property

$

$

	

	

Debentures

$

$

$

$

$

Shares Other (please specify)

Are any of the members of your household having difficulties with remaining in the current
departmental property due to any of the following reasons?
Note - please tick  all situations that apply to your household.

The family unit needs to reunite as they are currently living apart
You need to leave your current housing due to a risk of violence from another household member, neighbour or community member
There has been an irreversible family breakdown resulting in one of the joint tenants needing to live elsewhere (not a domestic violence situation)

You need to leave your current housing due to a domestic violence situation
The features of the current housing restrict household members from doing daily living activities (e.g. bathing, mobility)
A household member’s medical condition and/or disability is seriously aggravated by the current housing which cannot be readily modified to suit their needs
The property is overcrowded

If anyone in the household needs access to a specific location, please tick	one or more of the options that best describes the reasons.
Note - please tick  all situations that apply to your household.
To gain or maintain regular access to a child or children in foster care
To enable a child or children to be returned to the custody of a household member
To gain or maintain regular access to a child/children who are in the custody or care of another person To prevent a child or children being removed from the custody of a household member
To enable the shared care or a child or children
To ensure access to a specialist educational facility
To ensure access to a frequently needed medical facility or medical services required by a household member
To ensure access to support services required by a household member for daily living activities To ensure access to accessible transport services
To receive family or informal support on a regular basis that is necessary for daily living
To take up a firm offer of permanent employment (not casual/ temporary employment or a promotion)
To relocate under the Structured Training and Employment Program (STEP) program or Community Development Employment Program (CDEP) or other Commonwealth Government employment program for Indigenous people
You are an Aboriginal and/or Torres Strait Islander person needing to move for cultural reasons

If you ticked any of the reasons in the previous question, what locations do you need access to?

Can you get to this location?

Yes (see below)

No and there is no transport available

If yes, what type of transport do you use to access the required location/s?
Public transport (trains, bus, taxi, ferry etc)	Yes	No Own transport	Yes	No
Other transport (eg family/friends)	Yes	No	Details:

Declaration - legal tenant/s to sign
To the best of my knowledge, the information provided on and in conjunction with this form is true and correct. I/We understand that it is an offence liable to a penalty under the Housing Act 2003 and a breach of my State Tenancy Agreement to knowingly provide false or misleading information to the Department of Housing.

If this application is successful, I/we agree to accept the new property in its current condition.

Privacy Notice
The Department of Housing is collecting your personal information so we may provide you with housing assistance. To assist you with your housing needs and services, your personal information may be disclosed to partner agencies, service providers, local governments and non-governmental agencies that now, or will, provide you with housing and/or support services. Unless authorised or required by law, your personal information will not be disclosed to any other third party without your consent. More information about the Department’s privacy obligations is available on our website at www.housing.qld.gov.au.

Tenant name Signature Tenant name Signature

/	/

Date

Date  /	/

	

	

Please return completed form to your nearest Housing Service Centre.