Application to conduct a business from a departmental property

This form must be completed by the legal tenant/s and (if different) the household member conducting a business from a Department of Housing and Public Works property.

Tenant/s name/s		
		
Address of property		
		
		Postcode 		
				
Home phone:		Mobile:		
					
Tenancy Reference No.:		Email:		
How would you prefer to be contacted? (Phone, letter, SMS, email etc).  You may list more than one	
	
Details of business:	
Business name (if applicable):		
			
Type of business: 		
Is anybody employed in the business who is not normally a household member? 	Yes 	 No   	
If yes, will they live in the household? 	Yes 	 No 	
Note: if yes, please complete the New Household Member form (PH138) available from your nearest Housing Services Centre. 	
Conditions for the approval to conduct a business:	
1. 	The tenant/s and other household members must continue to live in the property on a full time basis. 	
2.	The business would not adversely affect the neighbourhood and the property. 	
3.	The business complies with all relevant government regulations and Local Government laws.  	
4.	The property is not used for illegal purposes. 	
5.	The business itself is not illegal. 	
6.	The tenant/s will provide details of income received from the business for each rent review. 	
7.	The tenant/s will take out all relevant insurances (e.g. Workers Compensation, Public Liability etc) and provide copies to the department. The tenants are responsible for maintaining insurance at all times and for informing the department when the business type or insurance has changed or lapsed.	
8.	There are no more than two employees and the employer working at the premises at any one time. Special circumstances will be considered on a case by case basis.	
Note: You have 28 days from submitting this form to provide a copy of the relevant insurance taken out for the business and, if applicable, evidence that your business complies with relevant government regulations and local government laws. If evidence is not provided within 28 days, approval to conduct the business will not be provided.
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.
Declaration:
•	To the best of my/our knowledge, the information provided on and in conjunction with this form is true and correct. I/We understand that it is an offence liable to a penalty under the Housing Act 2003 and a breach of my State Tenancy Agreement to knowingly provide false or misleading information to the Department of Housing and Public Works.
•	I/we understand the above conditions and agree to abide by them. 
•	I/we understand that if approval is given by the department, it is on the understanding the above conditions are always complied with.	
	Tenant		Tenant		Household member	
Name		Name		Name		
			
Signature 		Signature		Signature		
			
Date	/        /	Date	/        /	Date	/        /	

        Please return completed form to your nearest Housing Service Centre.