TICA Check

Are you an external support service completing this application with the client? *

YesNo

The TICA database listings are only valid for 3 years, has the tenancy ended in the last 5 years? *

YesNo

DO NOT COMPLETE THIS FORM

The TICA check cannot be completed as the tenancy has not ended in the last five years. Please contact Beyond Housing Private Rental Assistance Program if you require additional information

Support agency *

If your organisation name does not appear, choose other and type the name in the text box provided.

If other support agency, please describe *

Support worker name

Support worker email address

BeyondHousing staff member email *

Date of application *

BeyondHousing office email *

e.g. shepparton@beyondhousing.org.au. seymour@beyondhousing.org.au, wodonga@beyondhousing.org.au. wangaratta@beyondhousing.org.au

Will the client sign this form by email? *

YesNo

Will a copy of the TICA application outcome be emailed to the client? *

YesNo

Primary client details for TICA check

Surname *

First name *

Middle name/s

Date of birth *

Age

Gender *

Mobile/phone number

Email *

SHIP ID

Address

Country of birth *

Passport number, if not born in Australia

Additional household members

NB: A TICA check will be done for anyone aged 18 or over

Tick to add HM1

Name *

Date of Birth *

Age

Gender *

Relationship to primary client *

Tick to add HM2

Name *

Date of Birth *

Age

Gender *

Relationship to primary client *

Tick to add HM3

Name *

Date of Birth *

Age

Gender *

Relationship to primary client *

Tick to Add HM4

Name *

Date of Birth *

Age

Gender *

Relationship to primary client *

Tick to add HM5

Name *

Date of Birth *

Age

Gender *

Relationship to primary client *

Tick to add HM6

Name *

Date of Birth *

Age

Gender *

Relationship to primary client *

Gender Options: Female, Male, Other, Prefer not to say

Criteria

Has the client been in private rental previously, for longer than 6 months *

YesNo

How many rental applications have been rejected (a minimum of 3) *

Is the client able to find and afford private rental now *

YesNo

Were there any previous issues that may have been recorded at the previous tenancy *

YesNo

Is the client engaging with your service *

YesNo

Is the client currently receiving Centrelink payments, or are they on a low income (under $26,000) *

YesNo

Please list other names the main presenting client may have been known as over the last five years

Agreement

Name *

Of *

I agree for BeyondHousing to conduct a check on the TICA database for myself and anyone aged over 18 on this application. This check is to verify if I/we have a record on TICA that may be influencing my/our applications for private rental. I agree to be contacted at any time to verify further details in relation to this application for up to three months from the date below. *

Client signature

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Date

Witness signature

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Date

Witness name *

Witness position *

Assigned to PRAP worker

Assigned to PRAP worker (email) *

Assigned by (email) *

Date assigned *

Outcome

Date TICA check conducted *

History information found *

YesNo

If yes, the following was found in TICA

Number of tenancy enquiries found on TICA

Details of Rental Providers/Real Estate Agents who have checked TICA

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