Schedule 4

Forms

In force

[r. 10AC and 18]

[Heading inserted: Gazette 3 May 2013 p. 1757; amended: SL 2024/149 r. 14.]

[Form 1AA to 1AD deleted: SL 2024/149 r. 15.]

FORM 1

Residential Tenancies Act 1987

Section 27C(6)

PROPERTY CONDITION REPORT

HOW TO COMPLETE THIS FORM

1. Before the tenancy begins, the lessor or the property manager should inspect the residential premises and record the condition of the premises by indicating whether the particular room item is clean, undamaged and working by placing “Y” (YES) or “N” (NO) in the appropriate column. Where necessary, comments should be included in the report.

2. Two copies of the report, which has been filled out and signed by the lessor or the property manager, must be given to the tenant within 7 days of the start of the tenancy as specified in the residential tenancy agreement.

3. As soon as possible after the tenant receives the property condition report, the tenant should inspect the residential premises and complete the tenant section on both copies of the report. The tenant indicates agreement or disagreement with the condition indicated by the lessor or the property manager by placing “Y” (YES) or “N” (NO) in the appropriate column and by making any appropriate comments on the form.

4. The tenant must return one copy of the completed property condition report to the lessor or the property manager within 7 days after receiving it. The tenant should keep the second copy of the property condition report.

5. If photographs or video recordings are taken at the time the property inspection is carried out, it is recommended that all photographs or video recordings are signed and dated by all parties.

NOTE: Photographs and/or video recordings are not a substitute for accurate written descriptions of the condition of the property.

6. As soon as practicable, and in any event within 14 days after the termination of the tenancy agreement, the lessor or the property manager should complete a property condition report, indicating the condition of the premises at the end of the tenancy. This should be done in the presence of the tenant, unless the tenant has been given a reasonable opportunity to be present and has not attended the inspection.

IMPORTANT NOTES ABOUT THIS PROPERTY CONDITION REPORT

1. This property condition report is an important record of the condition of the residential premises when the tenancy begins. It may be used as evidence of the state of repair or general condition of the premises at the commencement of the tenancy if there is a dispute, particularly about the return of the security bond money and any damage to the premises. It is important to complete the property condition report accurately.

2. A property condition report must be filled out whether or not a security bond is paid.

3. At the end of the tenancy the premises must be inspected and the condition of the premises at that time will be compared to that stated in the original property condition report.

4. A tenant is not responsible for fair wear and tear to the premises. Fair wear and tear is a general term for anything that occurs through ordinary use such as the carpet becoming worn in frequently used areas. Wilful and intentional damage, or damage caused by negligence, is not fair wear and tear.

5. If you do not have enough space on the report, attach a separate sheet. All attachments should be signed and dated by all of the parties to the residential tenancy agreement.

6. Information about the rights and responsibilities of lessors and tenants may be obtained by contacting the Department of Energy, Mines, Industry Regulation and Safety on 1300 30 40 54 or visiting <www.dmirs.wa.gov.au/ConsumerProtection>.

ADDRESS OF RESIDENTIAL PREMISES: ___________________________

	Clean	Undamaged	Working	Tenant agrees	Comments
ENTRY
front door
screen door/ security door
walls/picture hooks
windows/screens
ceiling
light fittings
blinds/curtains
power points
floorcoverings
LOUNGE ROOM
doors/doorway frames
walls/picture hooks
windows/screens
ceiling
light fittings
blinds/curtains
TV/power points
floorcoverings
DINING ROOM
doors/doorway frames
walls/picture hooks
windows/screens
ceiling
light fittings
blinds/curtains
power points
floorcoverings
KITCHEN
doors/doorway frames
walls/picture hooks
windows/screens
ceiling
light fittings
blinds/curtains
power points
floorcoverings
cupboards/drawers
bench tops/tiling
sink/taps
stove top/hot plates
oven/griller
exhaust fan/ range hood
EACH BEDROOM
doors/doorway frames
walls/picture hooks
windows/screens
ceiling
light fittings
blinds/curtains
power points
floorcoverings
EACH BATHROOM
doors/doorway frames
walls/tiles
windows/screens
ceiling
light fittings
blinds/curtains
power points
floorcoverings
bath/taps
shower/screen/taps
wash basin/taps
mirror/cabinet/vanity
towel rails
toilet/cistern/seat
toilet roll holder
heating/exhaust fan/vent
LAUNDRY
doors/doorway frames
walls/tiles
windows/screens
ceiling
light fittings
blinds/curtains
power points
floorcoverings
washing machine taps
exhaust fan/vent
washing tub
SECURITY/ SAFETY
smoke alarms
electrical safety switch
keys/other opening devices
GENERAL
garden
lawn/edges
letterbox/ street number
water tanks/ septic tanks
garbage bins
paving/driveways
clothesline
garage/carport/ storeroom
garden shed
hot water system
gutters/downpipes

APPROXIMATE DATES WHEN WORK LAST DONE ON RESIDENTIAL PREMISES

Painting of premises (external): .............................................................................

Painting of premises (internal): .............................................................................

Floorcoverings laid: ...............................................................................................

Floorcoverings professionally cleaned: .................................................................

Note: Further items and comments may be recorded on a separate sheet, signed by the lessor/property manager and the tenant, and attached to this report.

............................................................

Lessor/property manager’s signature

Date: .................................................

..........................................................

Tenant’s signature

Date: ................................................

[Form 1 inserted: Gazette 3 May 2013 p. 1817-24; amended: SL 2024/149 r. 16.]

FORM 1A

RESIDENTIAL TENANCIES ACT 1987

Section 61(a)

NOTICE OF TERMINATION FOR NON‑PAYMENT OF RENT

(NOTE: This form is ONLY to be used if not less than 14 days’ notice of breach of the agreement to pay rent has been given.)

TO...........................................................................................................................

(Name of tenant(s))

I hereby give you notice of termination of your residential tenancy agreement and require you to deliver up vacant possession of the premises at —

.................................................................................................................................

(Address of rented premises)

.................................................................................................................................

(Date on which vacant possession of the premises is to be given)

This notice of NOT LESS THAN 7 DAYS is given to you on the ground that you have breached the agreement to pay rent and the rent or any part of the rent due remains unpaid. (See section 62 of the Residential Tenancies Act 1987.)

Notice of the breach was given to you on...............................................................

DATE: .................................... SIGNED: ..............................................................

(Lessor/property manager)

ADDRESS: ............................................................................................................

.....................................................................................POST CODE: ....................

IMPORTANT INFORMATION FOR TENANTS

The lessor is seeking to terminate your residential tenancy agreement and requires you to vacate the premises on the date specified in this notice.
This notice has no effect unless you were given a notice specifying the breach of the agreement and requiring payment of the rent not less than 14 days before you were given this notice.
If you do not vacate the premises, the lessor may apply to court for an order terminating your residential tenancy agreement and requiring you to vacate the premises.
If you pay the rent due under the agreement after receiving this notice, the payment will not prevent the lessor applying in court for an order terminating your residential tenancy agreement and requiring you to vacate the premises.
You should contact the lessor or property manager of the premises immediately to try and resolve this matter.
You should seek advice immediately if you do not understand this notice or if you require further information.

[Form 1A inserted: Gazette 25 Jun 1996 p. 2412‑13; amended: Gazette 3 May 2013 p. 1825.]

FORM 1B

RESIDENTIAL TENANCIES ACT 1987

Section 61(a)

NOTICE OF TERMINATION FOR NON‑PAYMENT OF RENT

(NOTE: This form is ONLY to be used if notice of breach of the agreement to pay rent has NOT been given.)

TO...........................................................................................................................

(Name of tenant(s))

I hereby give you notice of termination of your residential tenancy agreement and require you to deliver up vacant possession of the premises at —

.................................................................................................................................

(Address of rented premises)

.................................................................................................................................

(Date on which vacant possession of the premises is to be given)

DATE: .................................... SIGNED: ..............................................................

(Lessor/property manager)

ADDRESS: ............................................................................................................

.....................................................................................POST CODE: ....................

IMPORTANT INFORMATION FOR TENANTS

The lessor is seeking to terminate your residential tenancy agreement and requires you to vacate the premises on the date specified in this notice.
If you pay the rent due under the residential tenancy agreement in full before the date specified in this notice, you do not need to vacate the premises and no further action will be taken.
If you do not pay the rent due under the agreement in full and do not vacate the premises, the lessor may apply to court for an order terminating your residential tenancy agreement and requiring you to vacate the premises.
The lessor cannot continue an application for a court order if you pay to the lessor the rent due under the residential tenancy agreement together with the court application fee in full not less than one day before the court hearing.
You should contact the lessor or property manager of the premises immediately to try and resolve this matter.
You should seek advice immediately if you do not understand this notice or if you require further information.

[Form 1B inserted: Gazette 25 Jun 1996 p. 2913‑14; amended: Gazette 3 May 2013 p. 1825.]

FORM 1C

RESIDENTIAL TENANCIES ACT 1987

Section 61(a)

NOTICE OF TERMINATION

(NOTE: This form is NOT to be used in respect of non‑payment of rent.)

TO .....................................................................................................................

(Name of tenant(s))

I hereby give you notice of termination of your residential tenancy agreement and require you to deliver up vacant possession of the premises at:

..............................................................................................................................

(Address of rented premises)

..............................................................................................................................

(Date on which vacant possession of the premises is to be given)

ONLY ONE OF THE FOLLOWING GROUNDS IS TO BE SPECIFIED — DELETE THE OTHER 6

1. This notice of NOT LESS THAN 7 DAYS is given to you on the ground that you have breached a term of the agreement and the breach has not been remedied (see the Residential Tenancies Act 1987 section 62).

Particulars of the breach are:

...................................................................................................................

Notice of the breach was given to you on ................................................

(Note: This notice has no effect unless you were given a notice specifying the breach and requiring that the breach be remedied not less than 14 days before you were given this notice.)

2. This notice of NOT LESS THAN 30 DAYS is given to you on the ground that the lessor has entered into a contract for sale of the premises and under the contract he or she is required to give vacant possession of the premises (see the Residential Tenancies Act 1987 section 63).

(Note: This notice cannot be given during the term of a fixed term residential tenancy agreement.)

3. This notice of NOT LESS THAN 60 DAYS is given to you in exercise of the lessor’s right to give notice without specifying any ground for doing so (see the Residential Tenancies Act 1987 section 64).

(Note: This notice cannot be given during the term of a fixed term residential tenancy agreement.)

4. This notice of NOT LESS THAN 7 DAYS is given to you on the ground (see the Residential Tenancies Act 1987 section 69) that the premises or part of the premises:

* have been destroyed

* have been rendered uninhabitable

* have ceased to be lawfully useable as a residence

* have been appropriated or acquired by an authority by compulsory process

(* delete as appropriate)

The lessor believes that this ground applies because .......................

...........................................................................................................

(Note: This notice can be given during the term of a periodic or a fixed term residential tenancy agreement.)

5. This notice of NOT LESS THAN 30 DAYS is given to you in exercise of the lessor’s right to end the residential tenancy agreement on its expiry date (see the Residential Tenancies Act 1987 section 70A).

(Note: This notice cannot be given during the term of a periodic residential tenancy agreement.)

6. This notice of NOT LESS THAN 60 DAYS is given to you on the grounds that the lessor has determined, as a result of an assessment carried out under the Residential Tenancies Act 1987 section 71D, that you are not eligible to reside in social housing premises, or to reside in the class of social housing premises to which the agreement relates (see the Residential Tenancies Act 1987 section 71C).

(Note: This notice can be given during the term of a periodic or a fixed term residential tenancy agreement.)

7. This notice of NOT LESS THAN 60 DAYS is given to you on the ground that the lessor has offered to enter into a new social housing tenancy agreement with you in respect of alternative premises (see the Residential Tenancies Act 1987 section 71H).

(Note: This notice can be given during the term of a periodic or a fixed term residential tenancy agreement.)

DATE: .......................................... SIGNED: ......................................................

(Lessor/property manager)

ADDRESS: ............................................................................................................

................................................................................... POST CODE: ....................

SEE OVER FOR IMPORTANT INFORMATION

FORM 1C — REVERSE

IMPORTANT INFORMATION FOR TENANTS

• The lessor is seeking to terminate your residential tenancy agreement and requires you to vacate the premises on the date specified in this notice.

• If you do not vacate the premises, the lessor may apply to court for an order terminating your residential tenancy agreement and requiring you to vacate the premises.

• You should seek advice immediately if you do not understand this notice or if you require further information.

[Form 1C inserted: Gazette 3 May 2013 p. 1826-9; amended: Gazette 30 Jun 2017 p. 3559.]

FORM 2

Notice of termination of tenant’s interest in residential tenancy agreement on grounds of family violence Residential Tenancies Act 1987 s. 67(2), 71AB(1) Residential Tenancies Regulations 1989 r. 18			Part A

Lessor	Family name:
	Other names:

Tenant	Family name:
	Other names:

Residential premises	Address: Postcode:

Notice	I, the tenant, give notice of the termination of my interest in the residential tenancy agreement on the grounds that I am, or my dependant is, likely to be subjected or exposed to family violence. The last day of my tenancy will be __________________________________ (a day that is not less than 7 days after the giving of this notice). I will move out of the residential premises on or before this day.

Accompanying document(s)	I attach 1 or more of the following: ❒ a 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 under the Residential Tenancies Act 1987 s. 71AB(2)(d).

Signature	Tenant:	Date:

Further information	See Part B of this form and also refer to the Residential Tenancies Act 1987 or contact the Department of Energy, Mines, Industry Regulation and Safety — Consumer Protection Division on 1300 304 054 or at <www.dmirs.wa.gov.au/ConsumerProtection>. For Translating and Interpreting Services please telephone TIS on 131 450 and ask to speak to the Department of Energy, Mines, Industry Regulation and Safety (1300 304 054) for assistance.

Important information about this notice		Part B

The types of tenancy agreements to which this notice applies This notice applies to all tenancy agreements under the Residential Tenancies Act 1987.

Period of notice by tenant A tenant can give the lessor 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 residential tenancy agreement. The period of the notice must not be less than 7 days before the termination day.

Co-tenants A lessor must give a copy of this notice (but not an accompanying document) to any co‑tenants named on the residential tenancy agreement within 7 days after receiving this notice. A co-tenant may, within 7 days after receiving a copy of this notice, give the lessor notice of termination of the co-tenant’s interest in the residential tenancy 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 residential tenancy agreement A co-tenant does not need to use a specific form to notify the lessor that they wish to terminate their interest in the residential tenancy agreement. They simply need to notify the lessor in writing.

Co-tenant remaining in residential premises Any co-tenants who wish to remain in the residential premises are entitled to do so and the existing tenancy agreement will continue to apply to them.

Documents must be kept confidential A lessor must not disclose information contained in this notice or an accompanying document to another person except as allowed by the Residential Tenancies Act 1987 or another written law. A penalty of a fine of up to $5 000 applies for failure to comply with this requirement. A lessor 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.

[Form 2 inserted: Gazette 9 Apr 2019 p. 1050‑1; amended: SL 2024/149 r. 17.]

[Form 3 deleted: Gazette 30 Jun 2017 p. 3559.]

[Form 4 deleted: Gazette 3 May 2013 p. 1830.]

[Form 5 deleted: Gazette 30 Jun 2017 p. 3559.]

FORM 6

Residential Tenancies Act 1987 section 88A(3) Infringement notice		Infringement notice no.
Alleged offender	Name: Family name
	Given names
	or Company name ____________________________________ ACN
	Address ________________________________________________ Postcode
Alleged offence	Description of offence ____________________________________
	Residential Tenancies Act 1987 s. Residential Tenancies Regulations 1989 r.
	Date / /20 Time a.m./p.m.
	Modified penalty $
Authorised person issuing notice	Name
	Signature
	Office
Date	Date of notice / /20
Notice to alleged offender	It is alleged that you have committed the above offence. If you do not wish to have the complaint of the alleged offence heard and determined by a court, pay the modified penalty within 28 days after the date of this notice. How to pay By post: Send a cheque or money order (payable to ‘Authorised Person — Residential Tenancies Act 1987’) to: Authorised Person — Residential Tenancies Act 1987 Department of Energy, Mines, Industry Regulation and Safety ‑ Consumer Protection Division Locked Bag 100 East Perth WA 6892 By credit card: Complete the following details and forward this form to the Authorised Person as detailed above: Card type: Cardholder name: Card number: Expiry date of card: Amount: Signature: In person: Pay the cashier at: Department of Energy, Mines, Industry Regulation and Safety, at any of the following locations: Cannington: Level 1, Mason Bird Building, 303 Sevenoaks Street Cannington Albany: Unit 2/129 Aberdeen Street Broome: Woody’s Arcade, 6/15 Dampier Terrace Bunbury: 8th Floor, 61 Victoria Street Geraldton: Post Office Plaza, 50‑52 Durlacher Street Kalgoorlie: Corner of Hunter and Broadwood Streets, West Kalgoorlie
	If you do not pay the modified penalty within 28 days, you may be prosecuted or enforcement action may be taken under the Fines, Penalties and Infringement Notices Enforcement Act 1994. Under that Act, some or all of the following action may be taken — your driver’s licence may be suspended, your vehicle licence may be suspended or cancelled, you may be disqualified from holding or obtaining a driver’s licence or vehicle licence, your vehicle may be immobilised or have its number plates removed, your details may be published on a website, your earnings or bank accounts may be garnished, and your property may be seized and sold.
	If you need more time to pay the modified penalty, you can apply for an extension of time by writing to the Authorised Person at the above postal address.
	If you want this matter to be dealt with by prosecution in court, sign here _________________________________________________ and post this notice to the Authorised Person at the above postal address within 28 days after the date of this notice.

[Form 6 inserted: Gazette 22 Sep 2006 p. 4128; amended: Gazette 24 May 2011 p. 1895; 3 May 2013 p. 1830-1; 20 Aug 2013 p. 3840; SL 2020/163 r. 48; SL 2024/149 r. 18.]

FORM 7

Residential Tenancies Act 1987 section 88A(7) Withdrawal of infringement notice		Withdrawal no.
Alleged offender	Name: Family name
	Given names
	or Company name _____________________________________ ACN
	Address _________________________________________________ Postcode
Infringement notice	Infringement notice no.
	Date of issue / /20
Alleged offence	Description of offence ____________________________________
	Residential Tenancies Act 1987 s. Residential Tenancies Regulations 1989 r.
	Date / /20 Time a.m./p.m.
Authorised person withdrawing notice	Name
	Signature
	Office
Date	Date of withdrawal / /20
Withdrawal of infringement notice [*delete whichever is not applicable]	The above infringement notice issued against you has been withdrawn. If you have already paid the modified penalty for the alleged offence you are entitled to a refund. * Your refund is enclosed. or * If you have paid the modified penalty but a refund is not enclosed, to claim your refund sign this notice and post it to: Authorised Person — Residential Tenancies Act 1987 Department of Energy, Mines, Industry Regulation and Safety ‑ Consumer Protection Division Locked Bag 100 East Perth WA 6892 Signature / /20

[Form 7 inserted: Gazette 22 Sep 2006 p. 4128‑9; amended: Gazette 24 May 2011 p. 1895; 3 May 2013 p. 1831; SL 2024/149 r. 19.]

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