To close this window immediately press Ctrl +W.  For information about how to browse incognito and/or erase your history, see www.esafety.gov.au

This form is for a long-stay tenant/s to give notice of the termination of their interest in an on-site home agreement on the grounds of family violence.  

It needs to be accompanied by 

• DVO
• a Family Court injunction or an application for a Family Court injunction
• a copy of a prosecution notice or indictment containing a charge relating to violence against the tenant or a court record of a conviction of the charge
• a report of family violence (evidence form) 

Important information about this notice

The types of on-site agreements to which this notice applies

This notice applies to on-site home agreements under the Residential Parks (Long-stay Tenants) Act 2006.

Period of notice by tenant

A long-stay tenant can give the park operator this notice if the tenant, or a dependant of the tenant, is likely to be exposed or subjected to family violence during the term of the on-site home agreement. The period of the notice must not be less than 7 days before termination day.

Co-tenants

A park operator must give a copy of this notice (but not an accompanying document) to any co-tenants named on the on-site home agreement within 7 days after receiving this notice.

A co-tenant may, within 7 days after receiving a copy of this notice, give the park operator notice of termination of the co-tenant’s interest in the on-site home agreement. This period of notice must not be less than 21 days before the termination day.

Notice by co-tenant to terminate their interest in the on-site home agreement

A co-tenant does not need to use a specific form to notify the park operator that they wish to terminate their interest in the on-site home agreement. They simply need to notify the park operator in writing.

Co-tenant remaining in on-site home

Any co-tenants who wish to remain in the on-site home are entitled to do so and the existing on-site home agreement will continue to apply to them.

Documents must be kept confidential

A park operator must not disclose information contained in this notice or an accompanying document to another person except as allowed by the Residential Parks (Long-stay Tenants) Act 2006 or another written law. A penalty of a fine of up to $5 000 applies for failure to comply with this requirement.

A park operator must ensure that information given to them in this notice and an accompanying document is kept in a secure manner so far as it is reasonably practicable to do so. A penalty of a fine of up to $5,000 applies for failure to comply with this requirement.