Administrative access amendment form 

This form should be completed by a tenant or applicant if they have viewed their file under Administrative Access and wish to add his/her own statement to that file. Specifically, this form should be used in cases where a tenant believes information on the file is misleading, incomplete, inaccurate or untrue.
 
Please note that in no circumstances can original documents be amended or removed.	
Applicant / Tenant Details	
Full Name:		
		
Date of Birth:	/         /	Application/Tenancy Reference Number		
		
Address:		
		
	                                                                                              	Postcode		
		
Phone Numbers:	Home		Mobile		Contact		
							
Email:		
		
Issue or documents that amendment relates to 		

I wish this amendment form to be placed on my tenancy file.	

	

 Privacy Notice

The Department of Housing and Public Works 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.
	
Signature		Date:	/       /	
Extra space is provided on second page.  Please ensure you sign and date both pages.	

Administrative access amendment form (cont’d)	
Full Name:		
	
Application/Tenancy Reference Number		 Date of Birth	       /         /	
	
          Address:		
	
	                                                                                        	Postcode		

	
Name		Signature		Date	/       /	

Please return completed form to your nearest Housing Service Centre