Housing New Zealand business initiated transfer interview sheet

• Title to show in iAuditor so you can identify it

• Note for staff: Prior to meeting with the customer attach a copy of their household composition from Kotahi.

Customer Information (All fields must be completed)

• Tenancy Reference

• Meeting date

  Date

• HNZ staff member

Customer details

• Name

• Address

• Mail address (if different)

• Mobile contact number

• Home contact number

• Work contact number

• Email address

Emergency contact details

• Name

• Address

• Mail address (if different)

• Mobile contact number

• Home contact number

• Work contact number

• Email address

• Relationship

Reason and date to move by

• What date does the tenant have to move?

  Date

• Business reason for transfer

Bedrooms

• Number of bedrooms in current home

  Select 1 2 3 4 5 6 7 8

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8

• Number of bedrooms required

  Select 1 2 3 4 5 6 7 8

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8

Letting areas

• In what area(s) would they prefer to live in?

Other current needs/requirements

• Is the current property modified for disability or special needs?

  Yes

  No

• If modified, is this still required?

  Yes

  No

• Is there a future rent effective date?

  Yes

  No

• What is this date?

  Date

• Is there a change to the type of property the customer will need?<br>(For example modifications or smaller/larger bedrooms)

  Yes

  No

• Has this family been identified for rheumatic fever?

  Yes

  No

• Does the tenant have any pets?

  Yes

  No

• Information regarding any pets

• Comments including description of specific housing needs

Household composition

• Record additional household members here. This information is being collected to identify overcrowding and under utilisation. This information may also be used to assist with identifying suitable match.

Household member

• Name

• Age

• Gender

• Relationship

Changes to household

• If the household composition is different to the tenant summary report please explain why.

• If there has been an increase in required bedrooms have you advised the customer that MSD will be in contact to make an appointment for an assessment?

  Yes

  No

Support agency contact details

• Record agency contact details here if these people are to be used as key contacts for any offers.

Agency

• Organisation

• Contact Person

• Address

• Work contact number

• Mobile contact number

• Email address

• Reason for agency support

Privacy statement

• Housing New Zealand collects information under the Housing Restructuring and Tenancy Matters Act 1992, the Residential Tenancies Act 1986 and the Housing Corporation Act 1974.
  
  The information you have provided in this form will be used to:
  - assist you with finding another house
  - set up and administer your Tenancy Agreement with Housing New Zealand
  - charge you the correct amount of rent
  - keep you informed about other Housing New Zealand services, information and opportunities
  - for statistical and research purposes, including Social Housing Outcomes Worth Study
  
  If you don't provide all the information asked for, Housing New Zealand may not be able to help with your housing needs.

Will Housing New Zealand give my information to anyone else?

• Housing New Zealand gives information about you to the Ministry of Social Development (MSD) so MSD can perform its role as the social housing agency. This information includes:
  - sending MSD a request to contact you to discuss an assessment if you have had a change in circumstances and require a different type of property (if required)
  - the address of your tenancy (or any new tenancy you accept) and the start and end dates
  - other details we may hold about you, your tenancy, and anyone else at the tenancy.

Declaration (to be signed by all tenants and their partners)

• In signing this form I/we acknowledge that:
  - I/We have read the information provided in this form, or the information has been read to me
  - the information provided in this form is true, correct and complete
  - I/We have read the Privacy Statement above, or the Privacy Statement has been explained to me, and I/we understand it
  - I/We understand that by signing this form I/we give permission for information about me/us to be used, given and received in accordance with the Privacy Statement.

• Tenant

  Sign

• Tenant

  Sign

• Tenant

  Sign