Property information
Provider business name	Click here to enter business name.
Reference number	MSD use only.
Date property is available	Click here to enter a date.
Full property address (please include the suburb and postal code)	Click here to enter street number.
Click here to enter street name.
Click here to enter suburb.
Click here to enter town/city.
Click here to enter postcode.
Market rent	$ Click here to enter rent amount.
Number of bedrooms	Insert number.
Mobility access	Click here to enter text.
Is there any further information relevant to the property?	Click here to enter text.
Preferred or suitable for what type of households eg over 65, families with children?	First: Click here to enter text.
Second: Click here to enter text.
Third: Click here to enter text.
Are you receiving rent funding for this property from any other source?
Property approved or declined
Name	Click here to enter name.
Date	15/08/2014
Agreed market rent	$ Click here to enter rent amount.
Property

Referred client information
Client name	Click here to enter name.
SWN	Click here to enter text.
Date of birth	Click here to enter date of birth.
Home phone	Click here to enter phone number.
Cell phone	Click here to enter phone number.
Priority rating	Click here to enter priority rating.
Number of bedrooms required	Click here to enter number of bedrooms.
Chosen letting area	Click here to enter letting area.
Calculated rate of IRR	Click here to enter rate of income-related rent.
Household information
Modified property required	Click here to enter text.
Household type	Click here to enter text.
Household	Ages of household members	Health and disability	Risk identified
Main applicant	Age	Click here to enter text.	Click here to enter text.
Person 2	Age	Click here to enter text.	Click here to enter text.
Person 3	Age	Click here to enter text.	Click here to enter text.
Person 4	Age	Click here to enter text.	Click here to enter text.
Person 5	Age	Click here to enter text.	Click here to enter text.
Person 6	Age	Click here to enter text.	Click here to enter text.
Person 7	Age	Click here to enter text.	Click here to enter text.
Person 8	Age	Click here to enter text.	Click here to enter text.
Property matching
Is this client a match for this property?
If the client was not a match, please provide your reasons	Click here to enter reasons.

Property offer outcome
Did you withdraw the property offer?	Click here to enter reasons.
Did the client accept the property offer?	Click here to enter client’s reason.
Is the client applying for financial assistance with advance rent and bond or a redirection of benefit?	Please complete the Rent and Bond Payment and Redirection Benefit application form with the client and send to the Centralised Unit Housing via ShareFile	Please provide the tenancy start date below Click here to enter a date.