Residential Tenancy Agreement

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Residential Tenancy

Agreement

HOW TO USE THIS AGREEMENT

1. This is a legally binding contract.

2. All tenancy agreements must be in writing. A separate

form of tenancy agreement for use for a Boarding House

Tenancy is available on our website.

3. This agreement must be completed in full and signed by

the tenant and landlord.

4. The landlord must provide the tenant with a copy of this

agreement prior to the commencement of the tenancy.

the property is a Unit Titles property, a copy of the

mostrecent Body Corporate rules must be aached to

thisagreement.

he rights and obligations set out in the Residential

Tenancies Act 1986 are implied in every residential tenancy

agreement (see pages 2, 3 and 4 of this agreement for

abrief outline of some of the key provisions of the

Residential Tenancies Act 1986).

o terms or conditions added to this agreement are valid

ifthey are contrary to the Residential Tenancies Act 1986.

andlords must include a signed statement with any new

tenancy agreement that covers what insulation a property

has in the ceilings, ﬂoors and walls, including where it is,

what type and what condition. This information can be

provided in the healthy homes standards compliance

statement included in this agreement (page 8).

9. From 1 December 2020, most new or renewed tenancy

agreements must also include speciﬁc information about

the landlord’s current level of compliance with the healthy

homes standards. For information on when a healthy

homes compliance statement is required, head to this

pageon our website: www.tenancy.govt.nz/healthy-

homes/compliance-statement

10. Landlords must also provide a statement to conﬁrm

theywill comply, or already do comply, with the healthy

homes standards. This statement can be combined with

the healthy homes standards compliance statement,

withone signature.

11.

andlords must include a statement about whether

theproperty is insured, and if so, what the excess is.

Theymust also include a statement informing the tenant

that a copy of their insurance policy is available on request.

12. All rental properties must meet the requirements in

regulations regarding insulation and smoke alarms.

13.

efore signing this agreement all parties should carefully

read it and seek information from Tenancy Services if

theyare unclear about what they are agreeing to.

14.

he parties must record their full names correctly.

15.

f a bond is paid, a Bond Lodgement Form must also

be completed.

onds must be lodged with Tenancy Services within

23 working days of being paid. This can be done online.

arties to tenancy agreements are subject to the

provisions of the Privacy Act 2020. Any information

provided on this agreement shall not be used or disclosed,

without consent, for any purpose other than the

administration of the tenancy or to pursue legal action.

18.

eing fees can’t be charged to tenants.

19.

f there is a problem between the tenant and landlord,

andthey can’t agree, Tenancy Services can help sort

it out. Visit www.tenancy.govt.nz/disputes o

r call us

forfree information on 0800 836 262.

MB_TEN /  /



www.tenancy.govt.nz

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OUTLINE OF THE PROVISIONS OF THE RESIDENTIAL TENANCIES ACT 1986 (RTA)

Please refer to the Residential Tenancies Act 1986 and amendments for the complete provisions.

Tenants and landlords! If you have problems, talk to each other. If you can’t sort it out, talk to us. We can help you sort

itout. Visit www.tenancy.govt.nz/disputes/self-resolution or call us for free information on 0800 TENANCY

(0800836 262)

1. Agreement

› Each party should keep a copy of this tenancy agreement.

› Changes in the particulars of either party must be notiﬁed

to the other party within 10 working days.

› This contract may not be enforceable against a tenant

under the age of 18 (a minor). The Contract and Commercial

Law Act 2017 may apply.

2. Contact details

› Each party must provide an email address and mobile

phone number if they have them.

› Each party must supply a physical address for service

in New Zealand where notices and other documents

relating to the tenancy will be accepted by them, or on

their behalf, even aer the tenancy has ended. Tenants

who supply the rental address as their address for service

should update this at the end of the tenancy. Parties may

also supply an additional address for service which can

include a PO Box, email or facsimile.

› If the landlord is going to be out of New Zealand for more

than 21 days and has to appoint an agent, the landlord

must give the tenant the agent’s name, contact address,

mobile phone number (if any), email address (if any) and

address for service.

3. Rent

› Landlords shall not require rent to be paid more than

2 weeks in advance, nor until rent already paid has been

used up.

› 60 days’ wrien notice must be given for rent increases.

› Rent shall not be increased within 12 months of the start

of the tenancy or the last rent increase.

› Also for rent to be increased in a ﬁxed-term tenancy,

it must be stated in the tenancy agreement.

› Receipts must be given immediately if rent is paid in cash.

4. Bond

› A bond is not compulsory, but a landlord may require

a bond of up to 4 weeks’ rent.

› Bonds must be lodged with the Ministry of Business,

Innovation and Employment within 23 working days

ofbeing paid.

› Receipts must be given for bond payments.

› If the property is sold, the landlord’s rights with regard

tothe bond pass to the purchaser of the property.

› The bond covers any damage or loss to the landlord

if the tenant’s obligations are not met, but does not

coverfair wear and tear.

5. Landlord’s responsibilities

› Provide and maintain the premises in a reasonable condition.

› Allow the tenant quiet enjoyment of the premises.

› Comply with all building, health and safety requirements

that apply to the premises.

› Comply with all requirements in respect of smoke alarms

imposed on the landlord by regulations.

› Landlords need to have working smoke alarms installed in

all their residential rental homes. Any replacement alarms

installed aer 1 July 2016 (other than hard-wired systems)

need to have long life baeries and a photoelectric sensor.

› Pay rates and any insurance taken out by the landlord.

› Not seize the tenant’s goods for any reason.

› Inform the tenant if the property is on the market for sale.

› Not interfere with the supply of any services

to the premises.

› If the landlord is in breach of these responsibilities,

the tenant(s) can apply to the Tenancy Tribunal.

› Appoint an agent and notify the tenant and Bond Centre of

the agent’s details whenever leaving New Zealand for more

than 21 consecutive days.

› Inform the tenant of any changes to the information in the

insurance statement within a reasonable time.

6. Tenant’s responsibilities

› Pay the rent on time.

› Keep the premises reasonably clean and tidy, and notify

the landlord as soon as any repairs are needed. You may

not withhold rent if you cannot get repairs done.

› Use the premises principally for residential purposes.

› Pay all electricity, gas, telephone, and metered

water charges.

› Replace baeries in smoke alarms as required.

› Not damage or permit damage to the premises, and to

inform the landlord of any damage.

› Not disturb the neighbours or the landlord’s other tenants.

› Not alter the premises without the landlord’s wrien

consent.

› Not use the property for any unlawful purpose.

› Leave the property clean and tidy, and clear of rubbish

andpossessions at the end of the tenancy.

› At the end of the tenancy, leave all keys and such things

with the landlord. Leave all chaels supplied with the

tenancy.

› If a maximum number of occupants is stated in the

tenancyagreement, not exceed that number.

7. Rights of entry

The landlord shall enter the premises only:

› with the tenant’s consent at the time of entry

› in an emergency

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› for necessary maintenance or repairs, compliance

or preparation for compliance with any requirements

regarding smoke alarms, insulation and healthy homes

standards, from 8 am to 7 pm, aer 24 hours’ notice

› for an inspection of the property or work done by the

tenant, from 8 am to 7 pm aer 48 hours’ notice

› with the tenant’s prior consent, to show the premises

toprospective tenants, purchasers, registered valuer

orreal estate agent doing an appraisal, or other expert

engaged in appraising the premises (consent may not be

unreasonably withheld but reasonable conditions may

beimposed)

› to test for contamination from 8am to 7pm, aer 48 hours’

notice.

8. Subletting and assignment

› If not expressly prohibited by the landlord, the tenant may

sublet or part with possession with the landlord’s prior

wrien consent.

› Consent may not be unreasonably withheld unless

subleing is totally prohibited by this agreement.

› Landlords must consider all requests from tenants to

assign a tenancy and cannot withhold consent

unreasonably.Aprovision in a tenancy agreement

prohibiting assignment is of no eﬀect. These rules do not

apply to a social housing tenancy covered by section 53B(1)

(a) of the Residential Tenancies Act 1986 if assignment is

prohibited under this agreement.

› The tenant(s) must not assign the tenancy without the

prior wrien consent of the landlord.

9. Making changes to the property

› Landlords must consider all requests from tenants for

changes to the rental property, and must not withhold

consent for a minor change (ﬁxture, renovation, alteration,

or addition), but may aach reasonable conditions.

Responses to requests must be provided inwriting

within21 days.

› The tenant(s) must not make any changes without the

prior wrien consent of the landlord.

› The tenant(s) must return the property to a condition

thatis substantially the same as the condition that the

property was in before any minor changes were made.

However, the landlord and tenant may agree to a diﬀerent

arrangement in relation to the minor change for the end of

the tenancy (for example, that the minor change will

remain in place).

› Please check the www.tenancy.govt.nz website for further

information.

10. Installation of ﬁbre internet connection

Landlords must permit the installation of a ﬁbre internet

connection to the rental property if:

› there is no ﬁbre connection in the premises; and

› it is possible to install a ﬁbre connection in the premises;

and

› the tenant requests a ﬁbre connection; and

› the ﬁbre connection can be installed at no cost to the

landlord (for example, because the cost is covered by the

UFB Initiative).

Under some circumstances a landlord is not required

to permit installation. There are rules for how landlords

must respond to and facilitate requests for installation.

Please check the www.tenancy.govt.nz website for further

information.

11. Locks

Locks can only be changed with the agreement of both

the tenant and the landlord. They should be provided and

maintained in a secure state by the landlord.

12. Insulation

› Landlords must disclose the extent of insulation in

theirproperties in a signed statement as part of any

newtenancy agreement.

› Landlords must provide ceiling and underﬂoor insulation

that meets minimum standards unless they meet an

exception. In the case of an exception, the landlord must

explain how it applies.

› Landlords must make all reasonable eﬀorts to obtain

therequired information. This includes physically looking,

engaging a professional to do an assessment and/or

checking the council building ﬁle.

› This information can be included in the healthy homes

standards compliance statement included in this

agreement as a combined statement.

13. Insurance

› Landlords must disclose whether or not the property

isinsured in a statement as part of any new tenancy

agreement, and if so, the excess amount of any relevant

policies. They must also include a statement informing

thetenant that a copy of their insurance policy is available

onrequest.

› Landlords must provide tenants with this insurance

information (if requested within a reasonable timeframe)

and provide updated information within a reasonable

timeframe if insurance information changes, or (where

they are not the insurance holder) within a reasonable

timeframe of becoming aware of the changes.

› If tenants or their guests damage a rental property as a

result of careless behaviour, the tenant is liable for the

costof the damage up to four weeks’ rent or the insurance

excess (if applicable), whichever is lower. Tenants on

income-related rents are liable for the cost of the damage

up to four weeks’ market rent or the insurance excess

(ifapplicable), whichever is lower.

› Tenants will be liable for the full cost of damage that they or

their guests cause intentionally or that results from an act

or omission that constitutes an imprisonable oﬀence.

14. Healthy Homes Standards

From 1 July 2021, landlords must include a statement inall new

and renewed tenancy agreements, which includes details of

the property’s current level of compliance with the healthy

homes standards. This requirement is provided in regulations

34-39 of the Residential Tenancies (Healthy HomesStandards)

Regulations 2019.

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Landlords must include a statement in the tenancy agreement,

which conﬁrms:

› that on and aer the commencement of the tenancy, the

landlord will comply with the healthy homes standards as

required by section 45(1)(bb) of the Residential Tenancies

Act, or

› that the landlord already complies with the healthy homes

standards as required by section 45(1)(bb) of the

Residential Tenancies Act.

This statement can be combined with the healthy homes

standards compliance statement included in this agreement,

with one signature.

15. Notice to terminate tenancy*

Fixed-term tenancies

Fixed-term tenancy agreements that are entered into

from 11February 2021 and are for longer than 90 days,

will automatically convert to a periodic tenancy at the

end of the ﬁxed-term unless:

› the landlord gives wrien notice using one of the reasons

listed in the Residential Tenancies Act for terminating a

periodic tenancy with the same required notice period

(seebelow) to end the tenancy on the ﬁxed term expiry; or

› the tenant gives wrien notice (no reason is required)

atleast 28 days before the end of the tenancy, of their

intention to not continue with the tenancy; or

› before the expiry, both landlord and tenant agree to

extend, renew, or end the ﬁxed-term tenancy.

Periodic tenancies

Tenants terminating a periodic tenancy must give at least

28days’ written notice. Tenants may end the tenancy for

anyreason, and do not need to give a reason to the landlord.

Landlords are no longer able to terminate a periodic tenancy

without cause (without a reason) by providing 90 days’

written notice.

The landlord may give 63 days’ notice in writing – and must

state the reason for termination if:

› the premises are required as the principal place of

residence for the owner or any member of that owner’s

family, and is to be lived in within 90 days aer the

termination date, for at least 90 days; or

› the landlord customarily uses the premises for occupation

by employees or contractors and the premises are needed

for that purpose (and this is stated in the tenancy

agreement).

The landlord may give 90 days’ notice in writing – and must

state the reason for termination if:

› the owner intends to put the premises on the market

within 90 days aer the termination date

› the property has been sold with a requirement by the

owner for vacant possession

› the landlord is not the owner of the property, and the

landlord’s interest is due to end

› the premises need to be vacant to facilitate the use of

nearby land for a business activity (and this is stated

inthetenancy agreement)

› the landlord wants to change the use of the premises

toacommercial use for at least 90 days

› the landlord intends to carry out extensive alterations,

refurbishment, repairs, or redevelopment at the property

within 90 days of the termination date (or material steps

taken) and it would not be reasonably practicable for the

tenant to live there during that process

› the premises are to be demolished within 90 days of the

termination date (or material steps taken).

*This is not an exhaustive list of ways a tenancy may be

terminated.

The tenant can terminate the tenancy with two days’ notice if

the property was an unlawful residential premises at the start

of the tenancy and it is still an unlawful residential premises.

This applies to both ﬁxed term and periodic tenancies.

Family Violence

A tenant who is subjected to family violence during a tenancy

can withdraw from their tenancy by giving at least two days’

notice (with qualifying evidence of family violence) without

ﬁnancial penalty or the need for agreement from the landlord.

Physical Assault

The landlord can give notice of at least 14 days to terminate

atenancy if the tenant has assaulted the landlord, the owner,

a member of the landlord or owner’s family, or the landlord’s

agent, and evidence is provided that a charge has been ﬁled

byPolice against the tenant in respect of the assault.

16. Termination by Tribunal

The landlord may apply to the Tenancy Tribunal for a

termination order where:

› the rent is 21 days in arrears

› the tenant has caused or threatened to cause substantial

damage to the premises

› the tenant has assaulted, or threatened to assault,

the landlord, a member of the landlord’s family,

or a neighbour

› the tenant has failed to comply with a 14 days’ notice

to remedy a breach

› the premises are unlawful residential premises.

The landlord may apply to the Tenancy Tribunal for a

termination order of a periodic tenancy if:

› the landlord has given the tenant a wrien notices on

three separate occasions for anti-social behaviour within

any 90-day period; or

› the landlord has given the tenant a wrien notice on three

separate occasions when the tenant has missed their rent

payment and this has remained unpaid for at least ﬁve

working days within a 90-day period.

The landlord must apply to the Tenancy Tribunal within 28 days

of issuing the third notice. More information is available at

www.tenancy.govt.nz

A tenant may apply to the Tenancy Tribunal for a work order,

compensation or to terminate the tenancy, if the landlord has

breached the tenancy agreement or the Residential Tenancies

Act, or if the property is an unlawful residential premises.

17. Mitigation of loss

If one party to the tenancy agreement breaches it, the other

party must take all reasonable steps to limit the damage or

loss arising from the breach.

18. Unit Title Property

The landlord must notify the tenant of any variations to body

corporate rules affecting the premises.

Tenancy

LANDLORD DETAILS

Name(s)

This section must be ﬁlled in. It is important to give good contact details.

Physical address for service

This email address will be used as an address for services (strike out if not agreed)

Phone

(Mobile) (Hm) (Wk)

Other contact address(es)

Additional address for service

(This may be a PO Box)

If the landlord wishes to include the details of an agent in the agreement, please include the agent’s contact details

on a separate sheet.

TENANT DETAILS

Name(s)

Identiﬁcation

Driver’s licence Passport Other Write ID Number:

This section must be ﬁlled in. It is important to give good contact details.

Physical address for service

(This email will be used as an address for service (strike out if not agreed))

Phone

(Mobile) (Hm) (Wk)

Other contact address(es)

Additional address for service

(This may be a PO Box)

Is any tenant under the age of 18? (Tick one)

Yes No

TENANCY DETAILS

Address of tenancy

Body Corporate rules must be attached if premises are Unit Title premises

(Strike out if not applicable)

Rent per week $ To be paid in advanceFrequency (tick one) weekly fortnightly

Bond amount $

Rent to be paid at

Or into Bank Account No.

              

Account name

Bank Branch

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PAGE 

Tenancy

The landlord and tenant agree that:

1. The tenancy shall commence on the day of 20 .

2. Strike out one option:

This is a periodic tenancy and may be ended by either party giving notice as required under the Residential Tenancies Act 1986.

See page 4 of this agreement for more information.

This tenancy is for a ﬁxed term, ending on the

day of 20 .

NB: Fixed-term tenancies that are longer than 90 days, automatically become periodic upon the expiry of the ﬁxed-term, unless:

› a landlord gives written notice to end the tenancy on the ﬁxed term expiry using one of the reasons listed in the Residential Tenancies Act 1986

(see section 50(1)(a) to (b)) that allows for termination of periodic tenancies; or

› a tenant gives written notice of their intention not to continue with the tenancy at least 28 days before the expiry; or

› before the expiry, the parties agree to extend, renew or end the ﬁxed-term tenancy.

Note if the ﬁxed term is for 90 days or less, some tenancy laws do not apply.

Visit www.tenancy.govt.nz/starting-a-tenancy/types-of-tenancies/periodic-or-ﬁxed-term-tenancy/ for more information.

3. Strike out the bold wording below if it is not applicable

The tenant must not sublet the tenancy or part with possession (excluding assignment) without the landlord’s

wrienconsent.

Note: The tenant is allowed to assign a tenancy in accordance with the requirements of the Residential Tenancies Act 1986. Assignment may only be prohibited

bya social housing landlord where the tenancy is covered by section 53B(1)(a) of the Residential Tenancies Act 1986. If a social housing landlord wishes to prohibit

assignment they will need to amend this clause accordingly.

4. Insert other terms of this tenancy (eg. pets, maximum number of occupants, reimbursement of recovery costs, right of

renewal if tenancy is a ﬁxed-term)

If necessary, please continue on a separate sheet and attach it to this agreement and ensure that all parties have signed and dated it.

SIGNATURES

Do not sign this agreement unless you understand and agree with everything in it

The landlord and tenant sign here to show that they agree to all the terms and conditions in the tenancy agreement and that each

party has read the notes on pages 2, 3 and 4 of this agreement.

Signed by Date signed

LANDLORD

Signed by Date signed

TENANT

Signed by Date signed

TENANT

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PAGE 

Tenancy

INSURANCE STATEMENT

This insurance statement is for landlords, property managers and boarding house managers who can attach it to their

own tenancy agreement.

Law changes relating to insurance and damage

› Landlords are required to disclose whether or not the property is insured in a statement as part ofany new tenancy

agreement, and if so, the excess amount of any relevant policies. Landlords need to include information about insurance

thatis relevant to the tenant’s liability for damage to premises.

› If the rental property is part of a body corporate, landlords will need to include relevant insurance information for both

damage to the rental property itself, and the shared facilities.

› They must also include a statement informing the tenant that acopy of their insurance policy is available on request.

Thisensures that the tenant knows what actions or omissions could invalidate the insurance policy and also helps the

tenantto know what is covered by insurance and the excess payable on the insurance policy.

› Landlords must provide tenants with this insurance information (if requested within a reasonable timeframe) and provide

updated information within a reasonable timeframe if insurance information changes, or (where they are not the insurance

holder) within a reasonable timeframe of becoming aware of the changes.

› If tenants or their guests damage a rental property as a result of careless behaviour, the tenant is liable for the cost of the

damage up to four weeks’ rent or the insurance excess (if applicable), whichever is lower. Tenants on income-related rents are

liable for the cost of the damage up to four weeks’ market rent or the insurance excess (if applicable), whichever is lower.

› Tenants will be liable for the full cost of damage that they or their guests cause intentionally or that results from an act or

omission that constitutes an imprisonable oﬀence.

Insurance statement

Landlords must either complete this form or attach a statement containing the same information.

Address of tenancy

There is insurance covering this rental property that is relevant to tenant’s liability for damage

to premises, including damage to body corporate facilities.

Yes No

The table below speciﬁes the excess amounts of all relevant insurance policies for this property.

Name/type of policy Insurer Excess amount

. 

. 

. 

. 

The insurance policy for this property is available for the tenant if they request it. This ensures that the tenant knows what

actions or omissions could invalidate the insurance policy and also helps the tenant to know what is covered by insurance and

theexcess payable on the insurance policy.

If these insurance details change and theinformation above or the policy documents are no longer correct, you must provide the

correct information to your tenant within a reasonable time.

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PAGE 

Healthy Homes Standards

– current level of compliance

This healthy homes compliance statement must be included in all new or renewed

tenancyagreements.

The information that landlords must include is outlined inregulations 34-39 of the Residential Tenancies (HealthyHomes

Standards) Regulations 2019.

Landlords must either complete this form or attach a signed statement that contains thesame information.

ƨAddress of tenancy:

If properly completed this form meets the requirements for the landlord to provide a written signed statement

containing certain information as required under sections 13A(1A), 13A(1C) and 13A(1CA) or 13A(1CB) of the Act. If you

have the information, you must include it in this statement. If the information does not exist yet or otherwise cannot

be provided by the landlord, and this statement is completed before the healthy homes compliance date for the

tenancy, the landlord can state in the sections provided on this statement that compliance isn’t required until the

healthy homes compliancedate.

Information on when you need to comply with healthy homes requirements can be found at:

tenancy.govt.nz/healthy-homes/healthy-homes-compliance-timeframes

Completing this form does not negate the requirement since 1 July 2019 to include a statement in new, renewed or varied

tenancy agreements that conﬁrms landlords will or already do comply with the healthy homes standards as required by

either section 45(1)(bb) – residential tenancies, or section 66I(1)(bb) – boarding house tenancies, of the Residential Tenancies

Act 1986 (the Act).

It is necessary to provide both, separately signed, statements.

Strike out one option

I/we,

(name of the landlord(s))

willcomply with the healthy homes standards as required by section 45(1)(bb) of the Residential Tenancies Act.

I/we,

(name of the landlord(s))

alreadycomply with the healthy homes standards as required by section 45(1)(bb) of the Residential Tenancies Act.

The healthy homes compliance date for this tenancy is:



D M Y YD M Y Y

Heating standard compliance - the compliance date for the heating standard changes to 12 February 2023 if:

›

the rental property is considered a modern dwelling or relevant apartment for the purpose of assessing the required

heating capacity

›

the heating formula for modern dwellings and relevant apartments is being applied, and

›

the date entered above is on or aer 12 May 2022 and before 12 February, 2023

1 www.legislation.govt.nz/act/public/1986/0120/latest/DLM94278.html

2 See tenancy.govt.nz/starting-a-tenancy/tenancy-agreements/required-statements-for-tenancy-agreements/ for information on required statements

fortenancy agreements.

3 See tenancy.govt.nz/healthy-homes/heating-standard/calculating-heating-capacity for information on modern dwellings and relevant apartments when

calculating the required heating capacity.

Healthy Homes Standards Compliance Statement 8

General exemptions

In some situations your tenancy may be exempt from complying with all or parts ofthe

healthy homes standards

If one of the general exemptions below applies to your tenancy, state here and include a brief description of why this

exemption applies. If an exemption applies across all the standards, you do not need to complete the sections that relate

toeach standard.

›

The tenant is the immediate former owner of the property and the tenancy started immediately aer the landlord

acquired the property from the tenant. Thisexemption will only apply for 12 months from the tenancy startdate.

Include a brief description of the circumstances giving rise to this exemption:

›

The landlord intends to demolish or substantially rebuild the rental property and has applied for or has been granted

the relevant resource or building consent. This exemption will last for up to 12 months from the healthy homes

compliance date. Thisexemption will cease if the application for consent is refused (unless challenged) or the consent(s)

lapses or is terminated. This exemption will cease to apply if you receive a request to provide evidence that you have

applied for the relevant consent(s) and this evidence is not provided within 10 working days (or a time period provided

in a Tenancy Tribunal order).

Include a brief description of the circumstances giving rise to this exemption:

4 For more information on the general exemptions, visit tenancy.govt.nz/healthy-homes/exemptions-to-the-healthy-homes-standards/

Heating standard

For more information on all aspects of the heating standard, including a comprehensive

guidance document, visit tenancy.govt.nz/healthy-homes/heating-standard.

ƨHeating standard exemptions

Select one box from three options provided in question 1 about heating standard exemptions, then complete questions 2

to5 about compliance with the heating standard.

No heating exemption applies (continue to question 2)

Heating exemption: is the property exempt from meeting the heating standard?

Yes, the main living room is exempt from the requirement to have qualifying heaters and I am relying on the following

exemption

Give a brief description of the circumstances giving rise to this exemption.

5 There are two speciﬁc exemptions to the heating standard. More information on these is in the heating standard guidance document at

www.tenancy.govt.nz/assets/Uploads/ﬁles/healthy-homes-standards-heating.pdf

Healthy Homes Standards Compliance Statement 9

Partial exemption: the rental property is part

ofabuilding and the landlord doesn’t own the

wholebuilding. Provide speciﬁc information below

onhow this exemption applies to your property. If this

exemption applies you still need to complete the rest of

this statement. Landlords will still need to take all

reasonable steps to ensure the property complies with

the healthy homes standards to the greatest extent

reasonably practicable. This means if the required

heating capacity is over 2.4 kW, a landlord must install

Partial exemption from the heating standard as the

building Body Corporate rules do not allow the

installation of a heat pump on external walls as these are

part of the common property. There is no mains gas to

install a ﬂued gas heater and woodburners can’t be

installed.

EXAMPLES

at least one qualifying heater that has a heating capacity of at least 2 kW. A ﬁxed electric heater with thermostat is an

acceptable heater in this situation.

ƨHeating standard compliance

2. Required heating capacity for the main living room of the rental property:

You must calculate the required heating capacity for your rental property using one of the following two methods:

1. the Heating Assessment Tool at

tenancy.govt.nz/heating-tool

2. the appropriate formula contained in Schedule 2 of the Residential Tenancies (Healthy Homes Standards)

Regulations 2019

Alternatively, certain qualiﬁed specialists are able to assess the required heating capacity using criteria set out in

regulation 10A.

Select if applicable

For the purpose of calculating the required heating capacity, this rental property is considered a modern dwelling ora

relevant apartment as deﬁned in regulation 3 of the Residential Tenancies (Healthy Homes Standards) Regulations 2019

Give a brief description why the heating formula for modern dwellings/relevant apartments applies to this rental property.

4. The type(s) of qualifying heater(s) installed in the main living room (e.g. heat pump, ﬂued gas heater, modern wood

burner) and heating capacity/capacities. If there is more than one, make sure to include each heater, and please note

which heater has which kW:

Type of and heating capacity of each installed, qualifying heater:



6 www.legislation.govt.nz/regulation/public/2019

7 www.legislation.govt.nz/regulation/public/2019/0088/latest/whole.html#LMS147048

Healthy Homes Standards Compliance Statement 10

5. Does the ‘tolerance’ or ‘top up’

allowance for existing

heaters apply?

Yes If yes, include a brief description on why it applies:

› Required heating capacity is .kW and existing

heat pump (installed prior to  July ) has

capacity of .kW. A .kW ﬁxed electric heater

with a thermostat to top up to the required

amount has been installed.

› Existing (installed before  July ) woodburner

capacity is .kW. This is  of the required

heating capacity of .kW.

EXAMPLES

ƨAlternative pathway to compliance

NOTE

Questions 2 to 5 above also need to be answered if this section is being completed.

Select if applicable

The minimum required heating capacity for this property has been assessed by a suitably qualiﬁed specialist under the

requirements in regulation 10A of the Residential Tenancies (Healthy Homes Standards) Regulations 2019

Provide description on why this regulation applies:

Name and qualiﬁcations of specialist:

NOTE

If this section is being completed, the landlord must hold documentation that shows the name and relevant

qualiﬁcations of who made the assessment and a description of how the specialist calculated the required

heating capacity.

For the deﬁnition of suitably qualiﬁed specialist, visit tenancy.govt.nz/healthy-homes/heating-standard/

calculating-heating-capacity.

8 For an explanation of these allowances, visit: www.tenancy.govt.nz/healthy-homes/heating-standard/

9 www.legislation.govt.nz/regulation/public/2019/0088/latest/whole.html#LMS167168)

ƨGeothermal heating compliance

NOTE

Questions 2 to 5 above do not need to be answered if this section is being completed.

Select if applicable

The main living room is directly heated by geothermal heating and meets the requirements in regulation 10B of the

Residential Tenancies (Healthy Homes Standards) Regulations 2019.

Provide description on why this regulation applies:

For the deﬁnition of geothermal heating, visit tenancy.govt.nz/healthy-homes/heating-standard.

10 www.legislation.govt.nz/regulation/public/2019/0088/latest/whole.html#LMS167168)

Select if applicable

Some details regarding compliance with the heating standard for this tenancy have not been provided. This is

because the required information for the heating standard under regulation 34 of the Residential Tenancies

(HealthyHomes Standards) Regulations 2019 doesn’t exist yet or otherwise cannot be provided by the landlord.

Compliance with the heating standard is not required until the healthy homes compliance date for the tenancy, which

is noted on the front page of this statement.

Please note: You must provide this information if you have it. Alternatively, you must provide this information

if it exists and you can obtain it.

Insulation standard

For more information on all aspects of the insulation standard, including a comprehensive

guidance document, visit tenancy.govt.nz/healthy-homes/insulation-standard.

This section combines the requirements of the insulation statement (section 13A(1A) of the Residential Tenancies

Act1986) and healthy homes insulation information requirements (regulation 35 of the Residential Tenancies

(Healthy Homes Standards) Regulations 2019) into one statement. If you complete this section you do not need

tocomplete a separate insulation statement, which has been required in new tenancy agreements since 1 July 2016.

Theinsulation statement requires landlords to take all reasonable steps to ﬁnd information relating to the location,

type and condition of their current insulation. If any information below is already provided as part of a separate

insulation statement in the tenancy agreement, it does not need to be included again in this section. However,

it may be preferred to include all information on this form for ease and clarity of record-keeping.

Ceiling and underﬂoor insulation has been compulsory in all rental properties since 1 July 2019, unless an exemption

applies. Ceiling insulation and underﬂoor insulation for suspended ﬂoors is required in all areas of the premises,

unlessthese are areas:

›

that are not a domestic living space

›

of the ceiling that have a domestic living space directly above

›

of suspended ﬂoors that have a domestic living space directly below.

Healthy Homes Standards Compliance Statement 12

ƨCeiling insulation

1. Does the ceiling insulation above all domestic living spaces meet the requirements of the insulation standard? Complete

one of sections (a), (b) or (c) forthis question.



(A) YES – ENTIRE PREMISES

 R-value of ceiling insulation when it was installed

The R-value may be stapled to a beam in the area, or may be included in the council building ﬁle.

Landlordsneedto check all possible sources.

I don’t know the R-value

 If ceiling insulation exists, but you haven’t been able to ﬁnd out the R-value when installed, specify thickness

ofthe insulation when last inspected

If you’re unsure of insulation thickness, you may need to go into the ceiling cavity and physically measure the

insulation thickness.

The following four ﬁelds must be completed:

 Date insulation was installed (if known, or write ‘Unknown’)

 Date insulation was last inspected (if known, or write ‘Unknown’)

 Type of insulation (eg segments, loose-ﬁll, blanket)



I conﬁrm the insulation is in reasonable condition (without any mould, dampness, damage orgaps)



(B) YES – SOME AREAS OF THE PREMISES

 Specify which areas of the premises have ceiling insulation

 R-value of insulated areas when installed

The R-value may be stapled to a beam in the area, or may be included in the council building ﬁle. Landlords

need to check all possible sources.

I don’t know the R-value

– If ceiling insulation exists, but you haven’t been able to ﬁnd out the R-value when installed, specify thickness

ofthe insulation when last inspected

If you’re unsure of insulation thickness, you may need to go into the ceiling cavity and physically measure the

insulation thickness.

Healthy Homes Standards Compliance Statement 13

The following ﬁve ﬁelds must be completed:

 Date insulation was installed (if known, or write ‘Unknown’)

 Date insulation was last inspected (if known, or write ‘Unknown’)

 Type of insulation (eg segments, loose-ﬁll, blanket)



I conﬁrm the insulation is in reasonable condition (without any mould, dampness, damage orgaps)

 Specify all areas of domestic living spaces

in the premises that don’t have ceiling

insulation and that are exempt from this

requirement because it is not reasonably

practicable for a professional to install

insulation in these areas.

Bedroom  was an extension to the original property

and has a skillion ceiling with no roofspace to install

insulation.

EXAMPLE



 Does the premises meet the R-value exemption for ceiling insulation installed before 1 July 2016?

If this exemption applies it means the insulation does not need to meet the R-value required under the healthy

homes insulation standard. This exemption applies if

a) there is ceiling insulation that covers the ceiling at the premises; and

b) the insulation was installed before 1 July 2016; and

c) immediately before the healthy homes compliance date, the landlord met the insulation requirements

already in force ; and

d) the minimum thickness of the insulation material is at least 120 mm.

Yes

If yes, please provide a brief description of the circumstances giving rise to this exemption:

If no, specify the reason why the ceiling isn’t

insulated or why the existing insulation

doesn’tmeet the requirements of the insulation

standard, and any speciﬁc exemptionthat

applies.

Installation is not reasonably practicable because the

property has a skillion roof throughout and there is

not enough space for a professional installer to

access the areas to install insulation.

EXAMPLE

Healthy Homes Standards Compliance Statement 14

If ceiling insulation isn’t required because your

premises are exempt, but you are unsure if

there is any existing insulation, specify why an

exemption applies and include conﬁrmation

that you have taken all reasonable steps to ﬁnd

information about the existing insulation

(ifany). Note: cutting an access hatch doesn’t

count as substantial building work.

Insulation information is not provided in the council

building ﬁle. The ceiling space is also inaccessible and

substantial building work would be required to gain

access. Speciﬁcally, in order to access the ceiling

space, the roof would need to be lifted. The landlord

conﬁrms that all reasonable steps have been taken to

ﬁnd this information.

EXAMPLE

ƨUnderﬂoor insulation

2. Does the property meet the partial exemption for certain thermal underﬂoor insulation? This partial exemption means

that installed insulation doesn’t need to be a minimum R-value of 1.3 or have been installed in accordance with

NZS4246:2016 to be qualifying underﬂoor insulation. The insulation must still be in reasonable condition. Thisexemption

willcease to apply if you receive a request to provide reasonable evidence of the compliance document and this evidence

is not provided within 10 working days (or a time period provided in a Tenancy Tribunal order).

This partial exemption applies if:

a) there is underﬂoor insulation; and

b) when the insulation was installed, there were requirements relating to thermal insulation that applied to the premises

(under an enactment or bylaw); and

c) the landlord has a compliance document showing that when the insulation was installed, the premises met

theserequirements.

No (continue to question 3)

Yes (provide details below then continue to question3)

If yes, please provide a brief description of the

circumstances giving rise to this exemption:

Foil insulation is installed in the subﬂoor and Ihave

the appropriate compliance documents.

EXAMPLE

NOTE

The Building Act 2004 prohibits the installation and/or repair of foil insulation in residential buildings with existing

electrical installations. Anyone doing so may be liable to a ﬁne of up to $200,000. Existing foil insulation that is in

reasonable condition will only meet the healthy homes standards if it meets the criteria for an R-value partial

exemption

. In many cases, existing foil insulation will not meet the healthy homes insulation standard.

11 See the insulation guidance document at tenancy.govt.nz/healthy-homes/insulation-standard

Healthy Homes Standards Compliance Statement 15

3. Does the underﬂoor insulation meet the requirements of the insulation standard?

Complete one of sections (a), (b) or (c) for this question.



(A) YES – ENTIRE PREMISES

 R-value of underﬂoor insulation when installed

The R-value may be stapled to a beam in the area, or may be included in the council building ﬁle. Landlords

need to check all possible sources.

 Type of insulation (eg segments, polystyrene, foil, blanket)



I conﬁrm the insulation is in reasonable condition (without any mould, dampness, damage or gaps)

 Date insulation was installed (if known, or write ‘Unknown’)

 Date insulation was last inspected (if known, or write ‘Unknown’)



(B) YES – SOME AREAS OF THE PREMISES

 Specify which areas of the premises have underﬂoor insulation

 R-value of underﬂoor insulation in those areas when installed

 Type(s) of insulation (eg segments, loose-ﬁll, blanket, foil)



I conﬁrm the insulation is in reasonable condition (without any mould, dampness, damage or gaps)

 Date insulation was installed (if known, or write ‘Unknown’)

 Date insulation was last inspected (if known, or write ‘Unknown’)

 Specify all areas of domestic living spaces

with suspended ﬂoors in the premises that

don’t have underﬂoor insulation and that are

exempt from this requirement because it is not

reasonably practicable for a professional to

install insulation in these areas.

It is not reasonably practicable for a professional to

install underﬂoor insulation in some areas due to the

slope of the land, as there is not enough space under

the kitchen (including part of the hallway outside the

kitchen) and bedroom  for aprofessional to access

the area to install insulation.

EXAMPLE

12 This question does not need to be completed where the partial exemption for certain underﬂoor insulation applies (question 2 of this section)

Healthy Homes Standards Compliance Statement 16



 Specify the reason(s) why the underﬂoor area isn’t

insulated or why the existing insulation doesn’t

meet the requirements of the insulation standard,

and any speciﬁc exemption that applies

The property is built on a concrete slab, therefore

there is no suspended ﬂoor area inwhich to install

insulation.

EXAMPLE

 If underﬂoor insulation isn’t required because

your premises are exempt, but you are unsure

if there is any existing insulation, specify why

an exemption applies and include conﬁrmation

that you have taken all reasonable steps to ﬁnd

information about the existing insulation (if any).

Insulation information is not available in the council

building ﬁle. The underﬂoor space is also too narrow for

a professional assessor to gain access and provide an

assessment. The landlord conﬁrms that all reasonable

steps have been taken to ﬁnd this information. Note:

cutting an access hatch doesn’t count as substantial

building work.

EXAMPLE

ƨWall insulation

4. Do the walls of the premises have insulation? Complete one of sections (a), (b), (c) or (d) for this question.

NOTE

Wall insulation is not compulsory in rental properties, however you need to make reasonable effort to provide

the following information.



(A) YES – ENTIRE PREMISES

 Please provide any other details about the type or condition of the insulation (if known, or write ‘Unknown’

andexplain why, and include conﬁrmation that you have taken all reasonable steps to ﬁnd the information).



(B) YES – SOME AREAS OF THE PREMISES

 Specify which areas of the premises have wall insulation

Please provide any other details about the type or condition of the insulation (if known, or write ‘Unknown’

andexplain why, and include conﬁrmation that you have taken all reasonable steps to ﬁnd the information).

13 See tenancy.govt.nz/maintenance-and-inspections/insulation/insulation-exceptions for examples of access exceptions that may apply.



(D) I DON’T KNOW

 If you don’t know if there is wall insulation in any, or in some walls, explain why not and include conﬁrmation

that you have taken all reasonable steps to ﬁnd the information.

Select if applicable

For all parts where details have not been provided (except information required about the location, type and

condition of insulation in connection with any ceiling, underﬂoor or walls, or reasons for any general or speciﬁc

exemptions provided in a separate insulation statement), the required information for the insulation standard under

regulation 35 of the Residential Tenancies (Healthy Homes Standards) Regulations 2019 doesn’t exist yet orotherwise

cannot be provided by the landlord. Compliance with the insulation standard is not required until thehealthy homes

compliance date for the tenancy, which is noted on the front page of this statement.

Please note: You must provide this information if you have it. Alternatively, you must provide this information

if it exists and you can obtain it.

Select if applicable

If information about the location, type and condition of any insulation has not been provided in a separately

signedinsulation statement, this information must be provided as part of the healthy homes standards compliance

statement, unless despite making all reasonable efforts the landlord has been unable to obtain some of this

information. Thelandlord must specify what information he or she has been unable to obtain in relation to the

location, type andcondition of any ceiling, underﬂoor or wall insulation, why they have not been able to obtain

thisinformation, and conﬁrm that all reasonable efforts have been made to obtain the information.

Please note: Qualifying ceiling and underﬂoor insulation is now compulsory, unless an exemption applies,

and must be in a reasonable condition. Landlords in most cases should be able to provide this information.

Ventilation standard

For more information on all aspects of the ventilation standard, including a comprehensive

guidance document, visit tenancy.govt.nz/healthy-homes/ventilation-standard.

1. Do all habitable rooms in the property have one or more windows, doors or skylights that open to the outside and meet

the requirements below? Complete one of sections (a) or (b) for this question.

NOTE

Openable windows, doors or skylights need to be able to be ﬁxed in the open position. The combined area of

openable windows, doors or skylights must be at least 5% of the ﬂoor area

of each room. Habitable spaces are

allliving rooms, dining rooms, bedrooms and kitchens (ie spaces where people spend most of their time

athome).

14 For information on how to calculate this, see the ventilation guidance document at tenancy.govt.nz/assets/Uploads/ﬁles/healthy-homes-standards-

ventilation.pdf

Healthy Homes Standards Compliance Statement 18



(A) YES – ALL HABITABLE SPACES



(B) YES – SOME HABITABLE SPACES

 State which rooms meet the requirement

State which rooms don’t meet the requirement

 For each room that doesn’t meet the

requirement, brieﬂy state how the speciﬁc

exemption

applies.

The apartment does not have openable windows. However,

the rooms in the apartment can be ventilated by

mechanical ventilation, which was lawful at the time the

apartment was built. The mechanical ventilation continues

to meet the requirements of the building consent.

EXAMPLE

Ventilation for kitchens and bathrooms

Complete section 2 or 3.

ƨExtractor fans

2. Does each room in the rental property with an indoor cooktop, bath or shower have an extractor fan installed that vents

to the outside and is in good working order? Complete one of sections (a), (b) or (c) for this question.



(A) YES – ALL ROOMS

 State the diameter or exhaust capacity of each extractor fan and which room(s) they are located in.

Extractorfans that vent to the outside and were installed before 1 July 2019 don’t need to meet performance

requirements of the ventilation standard

. Inthis case, state below that you are relying on the modiﬁed

standard for extractor fans installed before this date.

15 A room does not need to meet the requirements for openable windows (including skylights) and external doors if it was lawful at the time it was built or

converted into a habitable space. If having fewer openable windows or doors was only lawful because the room met alternative ventilation requirements,

thenthose requirements must still be met to qualify for this exemption. For more information, see section 1.3.4 in the building code compliance document for

ventilation at building.govt.nz/assets/Uploads/building-code-compliance/g-services-and-facilities/g4-ventilation/asvm/g4-ventilation-4th-edition.pdf

16 Information on performance requirements for extractor fans is available at tenancy.govt.nz/healthy-homes/ventilation-standard/

Healthy Homes Standards Compliance Statement 19



(B) YES – SOME ROOMS

 State the diameter or exhaust capacity of each extractor fan and which room it is located in. Extractor fans that

vent to the outside and were installed before 1 July 2019 don’t need to meet performance requirements of the

ventilation standard. Inthis case, state below that you are relying on the modiﬁed standard for extractor fans

installed before this date.

 State which rooms don’t have extractor

fans installed and provide brief information

about why each room is exempt

The rental property is on the third ﬂoor of a ﬁve ﬂoor

building. A licensed electrician has advised that installing an

extractor fan in the kitchen is not reasonably practicable.

The room was lawful when built as it met the Building Code

ventilation requirements for kitchens at the timeby

providing windows with a combined net-openable area of

no less than  of the kitchen ﬂoor area. These openable

windows arestill present and functional.

EXAMPLE



 Provide brief information about why each

room is exempt:

The rental property is on the third ﬂoor of a ﬁve ﬂoor

building. There is one kitchen and one bathroom. Alicensed

electrician has advised that installing extractor fans in both

the kitchen and bathroom is not reasonably practicable.

The rooms were lawful when built as they met the Building

Code ventilation requirements for kitchens and bathrooms

at the time by providing windows with a combined

net-openable area of no less than  of the ﬂoor area of

each respective room. Theseopenable windows are still

present and functional.

EXAMPLE

ƨContinuous mechanical ventilation

3. Select if applicable:



(A) THE RENTAL PROPERTY HAS A MECHANICAL VENTILATION SYSTEM THAT:

 is designed to vent extracted air continuously from residential premises to the outdoors, and for a kitchen or

bathroom, extracts the air directly from the room, and

 was installed in the premises or a tenancy building that ﬁrst received building consent on or aer

1 November 2019 and was part of that original building consent, and continues to meet the requirements

of the building consent.

17 There are a number of criteria which must all be met to meet this exemption. Details are available in the guidance document:

tenancy.govt.nz/assets/Uploads/ﬁles/healthy-homes-standards-ventilation.pdf

Healthy Homes Standards Compliance Statement 20

Select if applicable:



(B) THE RENTAL PROPERTY HAS BEEN RETROFITTED WITH A CONTINUOUS MECHANICAL VENTILATION

SYSTEM THAT:

 is designed to vent extracted air continuously from residential premises to the outdoors, and

 for a kitchen or bathroom, extracts the air directly from the room, and

 is designed to provide ventilation for multiple rooms, with an exhaust capacity of at least 12ℓ/s for the kitchen

and at least 10ℓ/s for the bathroom.

Include a brief description of how the kitchen and bathroom(s) in the rental property meets one the above deﬁnitions,

including the exhaust capacity.

NOTE

Recirculating systems (products like HRV and DVS systems), or fans that do not extract to the outdoors are not

suitable to meet the ventilation standard.

Select if applicable

For all parts where details have not been provided, the required information for the ventilation standard under

regulation 36 of the Residential Tenancies (Healthy Homes Standards) Regulations 2019 doesn’t exist yet or otherwise

cannot be provided by the landlord. Compliance with the ventilation standard is not required until the healthy homes

compliance date for the tenancy, which is noted on the front page of this statement.

Please note: You must provide this information if you have it. Alternatively, you must provide this information

if it exists and you can obtain it.

Moisture ingress and drainage standard

For more information on all aspects of the moisture ingress and drainage standard,

including a comprehensive guidance document, visit tenancy.govt.nz/healthy-homes/

moisture-and-drainage-standard/

1. Does the property have gutters and downpipes that efﬁciently drain storm water, surface water, and ground water to an

appropriate outfall? An appropriate outfall will generally be the storm water system provided by your local council. It

could also be a properly working soakage system, natural watercourse, adequate water storage system or other

constructed water way.

Yes

NOTE

It has been a requirement for all homes to have efﬁcient drainage for the removal of storm water, surfacewater

and ground water since 1947 as part of the Housing Improvement Regulations 1947.

2. Does the property have any enclosed subﬂoor spaces?

Healthy Homes Standards Compliance Statement 21

The subﬂoor is considered to be enclosed if the airﬂow into and out of the space is signiﬁcantly obstructed along atleast

50% of the perimeter.

Yes (continue to question 3)

No (continue overleaf to next section on draught stopping standard)

3. If the property has an enclosed subﬂoor, has a ground moisture barrier been installed that meets the requirements ofthe

standard?

Yes

Brieﬂy specify the reason why there is no moisture barrier.

There is limited space under the house or part of the

house and I have received conﬁrmation from a

professional installer that it is not reasonably

practicable to install a polythene ground moisture

barrier.

EXAMPLE

Select if applicable

For all parts where details have not been provided, the required information for the moisture ingress and drainage

standard under regulation 38 of the Residential Tenancies (Healthy Homes Standards) Regulations 2019 doesn’t exist

yet or otherwise cannot be provided by the landlord. Compliance with the moisture ingress and drainage standard is

not required until the healthy homes compliance date for the tenancy, which is provided on the front page of this

statement.

Please note: if you have this information or it exists and you can obtain it, you must provide it.

Draught stopping standard

For more information on all aspects of the draught stopping standard, including a

comprehensive guidance document, visit tenancy.govt.nz/healthy-homes/draught/

1. Does your property have any open ﬁreplaces?

Yes

If yes, have they been blocked oﬀ or do you hold wrien agreement from the tenant not to block them oﬀ? Specify whether

they have been blocked oﬀ, or are available for use at the tenant’s request:

For an open ﬁre to meet the requirements of the draught stopping standard the ﬁreplace and the chimney must be in good

working order and free from any gaps or holes that allow draughts to enter in and out of the property, unless these are

necessary for the safe and eﬃcient operation of the ﬁreplace. Use of the ﬁreplace must be agreed by both landlord and

tenant in writing.

18 See the guidance document tenancy.govt.nz/assets/Uploads/ﬁles/healthy-homes-standards-moisture-ingress-drainage.pdf for further information

ondetermining whether a subﬂoor area is enclosed.

Healthy Homes Standards Compliance Statement 22

2. Is the property free from unintentional and unreasonable gaps or holes that allow noticeable draughts in or out of

thebuilding? Areas include, but are not limited to, doors, windows, walls, ﬂoors and ceilings.

Yes

No (explain why some gaps or holes that allow noticeable draughts are not blocked).

To meet the requirements of the draught stopping standard the property must be free from unintentional and

unreasonable gaps or holes that allow noticeable draughts in and out of the property. A common sense approach should

be taken to assessing whether adraught is noticeable. The age and condition of the property must not be taken into

account when assessing if a gap orhole is unreasonable.

Refer to the draught stopping guidance document

when determining if a draught is unreasonable.

Select if applicable

For all parts where details have not been provided, the required information for the draught stopping standard under

regulation 37 of the Residential Tenancies (Healthy Homes Standards) Regulations 2019 doesn’t exist yet or otherwise

cannot be provided by the landlord. Compliance with the draught stopping standard is not required until the healthy

homes compliance date for the tenancy, which is provided on the front page of this statement.

Please note: if you have this information or it exists and you can obtain it, you must provide it.

ƨLandlord Statement

I/we,



(name of landlord(s))

declare that the information contained in this statement is true and correct as at the date of signing.

Signed by

LANDLORDS

Date signed

D M Y YD M Y Y

19 tenancy.govt.nz/healthy-homes/draught

Healthy Homes Standards Compliance Statement 23

Tenancy

PROPERTY INSPECTION REPORT

This report is intended to help avoid disputes

This should be used to record the condition of the property at the start of the tenancy.

The landlord and the tenant should ﬁll out this form together, and tick the appropriate box if the condition is acceptable,

or record any damage or defects.

CONDITION ACCEPTABLE?

ROOM AND ITEM LANDLORD TENANTS DAMAGE/DEFECTS

LOUNGE

Wall/Doors

Lights/Power points

Floors/Fl. Coverings

Windows

Blinds/Curtains

KITCHEN/DINING

Wall/Doors

Lights/Power points

Floors/Fl. Coverings

Windows

Blinds/Curtains

Cupboards

Sinks/Benches

Oven

Refrigerator

BATHROOM

Wall/Doors

Lights/Power points

Floors/Fl. Coverings

Windows

Blinds/Curtains

Mirror/Cabinet

Bath

Shower

Wash basin

Toilet (WC)

LAUNDRY

Wall/Doors

Lights/Power points

Floors/Fl. Coverings

Windows

Blinds/Curtains

Washing machine

Wash tub

BEDROOM 1

Wall/Doors

Lights/Power points

Floors/Fl. Coverings

Windows

Blinds/Curtains

BEDROOM 2

Wall/Doors

Lights/Power points

Floors/Fl. Coverings

Windows

Blinds/Curtains

BEDROOM 3

Wall/Doors

Lights/Power points

Floors/Fl. Coverings

Windows

Blinds/Curtains

RTA Residential Tenancy Agreement

www.tenancy.govt.nz

PAGE 

Tenancy

BEDROOM 4

Wall/Doors

Lights/Power points

Floors/Fl. Coverings

Windows

Blinds/Curtains

GENERAL

Rubbish bins

Locks

Garage/Car port

Grounds

No. keys supplied

Smoke alarms

Landlords must have working smoke alarms installed in all rental premises. These must meet the requirements in the

Residential Tenancies (Smoke Alarms and Insulation) Regulation 2016, set out below. A landlord who fails to comply is

committing an unlawful act and may be liable for a penalty of up to $7,200.

Landlord - please conﬁrm you have met at least these minimum legal requirements before you rent the premises:

There is at least one working smoke alarm in each bedroom or within three metres of each bedroom’s door – this applies

toany room a person might reasonably sleep in.

If there is more than one storey or level, there is at least one working smoke alarm on each storey or level, even if no-one

sleeps there.

If there is a caravan, sleep-out or similar, there is at least one working smoke alarm in it.

None of the smoke alarms has passed the manufacturer’s expiry or recommended replacement date.

All new or replacement smoke alarms, installed from 1 July 2016 onward, are long-life photoelectric smoke alarms withatotal

battery life when installed of at least eight years or a hard-wired smoke alarm system, and meet the product standards in

theResidentialTenancies (Smoke Alarms and Insulation) Regulation 2016.

All the smoke alarms are properly installed by the landlord or their agent in accordance with the manufacturer’s instructions.

All the smoke alarms are working at the start of the tenancy, including having working batteries.

For important details go to www.tenancy.govt.nz/smoke-alarms

List of furniture and chattels

Provided by the landlord

Water Meter Reading

For use if charging for water

At start of tenancy

Signatures for Property

Inspection Report

Do not sign unless you agree to all the details in the

Property Inspection Report

Signed by Date signed

LANDLORD

Signed by Date signed

TENANT

Rent and Bond Receipt

Initial rent payment $

Bond $

Total $

To (name)

Date paid

Signed as received

RTA Residential Tenancy Agreement

www.tenancy.govt.nz

PAGE 

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