Tenant Statement About Sexual or Domestic Violence and Abuse

The document is a form titled “Tenant Statement About Sexual or Domestic Violence and Abuse” designed for tenants to provide notice to their landlord of the need to end tenancy due to being a victim of domestic or sexual violence. It requires the tenant to declare the reason for leaving, with specifics about the nature of the violence or abuse and the relationship to the aggressor. It emphasizes the legal requirement for the information to be truthful and mentions potential legal consequences for providing false statements. Additional resources and contact information for the Landlord and Tenant Board are provided for further assistance.

To fill out this form, you need to provide specific information and follow these steps:

1. To and From Sections: Begin by filling out the landlord’s name and address at the top of the form, followed by your (tenant’s) name in the “From” section.
2. Address of Rental Unit: Clearly write the address of your current rental unit where you are experiencing the issues leading to this notice.
3. Reason for Notice: State that you or a child living with you has been a victim of domestic or sexual violence and believe there is a risk of harm if you continue to live in the rental unit. Specify the nature of the relationship with the aggressor (e.g., spouse, former spouse, someone you live or lived with in a conjugal relationship, someone you are or were dating, or a related person living in your unit).
4. Details of Violence or Abuse: Explain how the aggressor has caused bodily harm, damage to property, fear for safety, or any form of sexual violence as defined in the Residential Tenancies Act 2006.
5. Signature and Date: Sign the form and date it (dd/mm/yyyy) to validate the statement.
6. Legal Acknowledgment: Be aware that providing false information on this form is against the law and could lead to legal consequences, including fines.

Ensure all provided information is true to the best of your knowledge, as the form serves as a legal document intended to protect tenants in vulnerable situations.