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DH1096 - Housing Statement - Housing NSW

DH1096 - Housing Statement - Housing NSW 2026

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The document is a form for applicants or tenants of social housing to make a statement, which must be witnessed by a social housing provider officer. It includes personal information fields, privacy notices regarding the handling of data by the Department of Family and Community Services (FACS), and declarations about the accuracy of the information provided. The form emphasizes the legal consequences of providing false information and outlines the process for assistance in completing it.

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Click ‘Get Form’ to open the DH1096 in the editor.
Begin by filling in your Client Reference Number and T-File number at the top of the form. This information is crucial for identification purposes.
In the personal details section, provide your title (Mr, Mrs, Ms, Miss), last name, and given names. Ensure that you print in BLOCK LETTERS for clarity.
Next, enter your address details including unit/house number, street/avenue, town/suburb, postcode, phone number, and email. Double-check these entries for accuracy.
In the declaration section, read through the statements carefully. Confirm your understanding by signing and dating the form. If someone assisted you in filling it out, they must also complete their declaration.
If additional space is needed for your statement, attach a separate page as indicated on the form.

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