Tenancy Services
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 signed
copy of this agreement prior to the commencement of
the tenancy.
5. If the property is a Unit Titles property, a copy of the
most recent Body Corporate rules must be attached to
this agreement.
6. The 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).
7. No terms or conditions added to this agreement are
valid if they are contrary to the Residential Tenancies
Act 1986.
8. Landlords 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 compliance
statement included in this agreement.
9. New, varied or renewed tenancy agreements must
include specific information about the property's
compliance with the healthy homes standards.
For information on the requirements see tenancy.govt.
nz/healthy-homes/compliance-statement. A template
is provided.
10. Landlords must also include a statement to confirm
they comply, or will comply with the healthy homes
standards. This can be combined with the healthy
homes standards compliance statement with one
signature.
11. Landlords 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 for smoke alarms.
13. Before 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. The parties must record their full names correctly.
15. If a bond is paid, it must be lodged with Tenancy
Services within 23 working days of being paid. This can be
done online.
16. Parties 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.
17. Letting fees can't be charged to tenants.
18. If there is a problem between the tenant and landlord,
and they can't agree, Tenancy Services can help sort
it out. Visit tenancy.govt.nz/disputes or call us for free
information on 0800 836 262.
MINISTRY OF BUSINESS,
INNOVATION & EMPLOYMENT
HĪKINA WHAKATUTUKI
Te Kāwanatanga o Aotearoa
New Zealand Government

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 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 after 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 or electronic address.
>
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' written 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. Bonds
> Bonds are not compulsory, but a landlord may require
a general bond of up to 4 weeks' rent and a pet bond of
up to 2 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 on the
earlier date of settlement or possession.
›
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 the healthy homes standards.
>
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 after 1 July 2016 (other than hard-wired
systems) need to have long life batteries 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 Tenancy
Bond Service 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
1
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 batteries in smoke alarms as required.
RESIDENTIAL TENANCY AGREEMENT 2

>
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 written
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 chattels 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
›
for necessary maintenance or repairs, compliance
or preparation for compliance with any requirements
regarding smoke alarms and healthy homes standards,
from 8 am to 7 pm, after 24 hours' notice
> for an inspection of the property or work done by the
tenant, from 8 am to 7 pm after 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, after
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 written consent.
> Consent may not be unreasonably withheld unless
subletting 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
22F(2)(b) & (c) of the Residential Tenancies Act 1986 if
assignment is prohibited under this agreement.
The tenant(s) must not assign the tenancy without the
prior written consent of the landlord.
9. Pets
> Tenants must request consent to keep a pet on the
premises.
>
The landlord must respond to the request within 21 days.
›
The landlord must say yes to the pet request unless
there are reasonable grounds to say no.
>
Landlords can can set fair conditions when giving
consent. Please visit tenancy.govt.nz/pets for more
information.
10. 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 attach reasonable
conditions. Responses to requests must be provided
in writing within 21 days.
›
The tenant(s) must not make any changes without the
prior written 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 tenancy.govt.nz website for further
information.
11. 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 tenancy.govt.nz website for further
information.
12. 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.
13. 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.
RESIDENTIAL TENANCY AGREEMENT 3

›
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.
14. 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 there is a pet living at the property, all tenants are fully
responsible for any pet damage beyond fair wear and
tear. This includes damage resulting from keeping a pet.
1
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.
15. Healthy Homes Standards
Landlords must include a statement in all new, renewed
or varied tenancy agreements, which includes details of
the property's compliance with the healthy homes standards.
This requirement is provided in regulations 34-39 of the
Residential Tenancies (Healthy Homes Standards)
Regulations 2019.
Landlords must include a statement in the tenancy
agreement, which confirms:
1
that on and after 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.
16. Notice to terminate tenancy*
Fixed-term tenancies
Fixed-term tenancy agreements that are for longer than
90 days, will automatically convert to a periodic tenancy
at the end of the fixed-term unless:
›
the landlord or tenant gives written notice to end the
fixed-term tenancy between 90 and 21 days before the
fixed term ends. No specific reason is required; 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
21 days' written notice. Tenants may end the tenancy for
any reason, and do not need to give a reason to the
landlord.
Landlords are able to terminate a periodic tenancy without
cause (without a reason) by providing 90 days' written notice.
The landlord may give 42 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 after 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); or
>
the owner is required, under an unconditional agreement
for the sale of the premises, to give the purchaser vacant
possession; or
›
the landlord customarily uses the premises, or has
acquired the premises, for occupation by employees of a
school board of trustees or by contractors under
contracts for services with a school board of trustees.
That fact is clearly stated in the tenancy agreement, and
the premises are required for that use (this reason only
applies if the landlord is the Ministry of Education).
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 or their child/dependant 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.
RESIDENTIAL TENANCY AGREEMENT 4

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.
17. 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 written notices on
three separate occasions for anti-social behaviour within
any 90-day period; or
> the landlord has given the tenant a written 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 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.
18. 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.
19. Unit Title Property
The landlord must notify the tenant of any variations to
body corporate rules affecting the premises.
RESIDENTIAL TENANCY AGREEMENT 5

Landlord details
Name(s)
This section must be filled in. It is important to give good contact details.
Physical address for service
Email 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 (An additional address for service may be a PO Box or electronic address. An electronic address is an email address,
fax number, mobile telephone number, or instant messaging account through which information can be easily accessed and referred to.)
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
Email (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 (An additional address for service may be a PO Box or electronic address. An electronic address is an email address,
fax number, mobile telephone number, or instant messaging account through which information can be easily accessed and referred to.)
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
General bond $
Pet bond $
Total bond $
Rent to be paid at
Or into Bank Account No.
Account name
Bank
Branch
RESIDENTIAL TENANCY AGREEMENT 6

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.
OR
This tenancy is for a fixed term, ending on the
1
day of
JONE
20
27
Note:
Fixed-term tenancies that are longer than 90 days, automatically become periodic upon the expiry of the fixed-term, unless:
> the landlord or tenant gives written notice to end the fixed-term tenancy between 90 and 21 days before the fixed term
ends. No specific reason is required; or
> before the expiry, both landlord and tenant 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 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
written 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 section 22F(2)(b) & (c)
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. consent and any reasonable conditions for pets, no smoking indoors, maximum
number of occupants, reimbursement of recovery costs, right of renewal if tenancy is a fixed-term)
If there isn't enough space in this box, please include the additional information as an attachment to this tenancy agreement and ensure that all
parties have signed and dated it.
5. The parties acknowledge and agree that this agreement is governed by the provisions of the Residential Tenancies Act 1986.
For the avoidance of doubt, if your proposed arrangement is excluded under section 5 of the Residential Tenancies Act 1986,
by using this agreement you are contracting into the Residential Tenancies Act 1986 in its entirety, and all of the rights and
obligations contained therein will apply.
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
John
Vol
LANDLORD
DATE SIGNED
Signed by
A
RENTER
TENANT
DATE SIGNED
Signed by
TENANT
DATE SIGNED
RESIDENTIAL TENANCY AGREEMENT 7

Insurance statement
This insurance statement is for landlords, property managers and boarding house managers who can attach it to their
own tenancy agreement.
1
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.
> Tenants will be fully liable for pet-related damage that is beyond fair wear and tear.
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
1.
$
2.
$
3.
$
4.
$
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.
RESIDENTIAL TENANCY AGREEMENT 8

Tenancy Services
Healthy Homes Standards
compliance statement
All rental properties must comply with the healthy homes standards.
This healthy homes compliance statement must be included in all new, renewed or varied 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.
Address of tenancy:
i
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
Residential Tenancies Act 1986 (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 the requirements can be found at: tenancy.govt.nz/healthy-homes
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 661(1)(bb) - boarding house tenancies, of the
Act.1 It is necessary to provide both, separately signed, statements.2
Tick one option:
I/we,
(name(s) of landlord(s))
will comply with the healthy homes standards as required by section 45(1)(bb) of the Act.
(This can only be used for some residential tenancies. All other tenancies must already comply with the
Healthy Homes standards, unless an exemption applies. For further information when obligations apply
visit tenancy.govt.nz/healthy-homes.
I/we,
(name(s) of landlord(s))
comply with the healthy homes standards as required by either section 45(1)(bb) or 661(1)(bb) of the Act.
I/we,
(name(s) of landlord(s))
do not comply with the healthy homes standards as required by either section 45(1)(bb) or 661(1)(bb) of the Act as a
general exemption applies.
I/we,
(name(s) of landlord(s))
comply with the healthy homes standards as required by either section 45(1) (bb) or 661(1)(bb) of the Act, but the
following exemption(s) from specific standards apply:
Heating
Insulation
Ventilation
Moisture Ingress and Drainage
(The details of these exemptions are set out under relevant headings below.)
The healthy homes compliance date for this tenancy is:
/
DD
MM
YYYY
1
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.
MINISTRY OF BUSINESS,
INNOVATION & EMPLOYMENT
HĪKINA WHAKATUTUKI
Te Käwanatanga o Aotearoa
New Zealand Government

General exemptions
In some situations your tenancy may be exempt from complying with all or parts of the healthy homes standards3.
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 after 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 with that work to begin within the grace period. This
exemption will last for up to 12 months from the tenancy commencement 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:
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.
Heating 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.
1.
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 exemption4:
Give a brief description of the circumstances giving rise to this exemption.
3 For more information on the general exemptions, visit tenancy.govt.nz/healthy-homes/exemptions-to-the-healthy-homes-standards
4 There are two specific exemptions to the heating standard. More information on these is in the heating standard guidance document at
tenancy.govt.nz/assets/Uploads/files/healthy-homes-standards-heating.pdf
HEALTHY HOMES STANDARDS COMPLIANCE STATEMENT
10

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 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.
Example: 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.
Heating standard compliance
2. Required heating capacity for the main living room of the rental property:
kW
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 20195
Alternatively, certain qualified specialists are able to assess the required heating capacity using criteria set out in
regulation 10A.
3.
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 20196
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:
kW
kW
kW
5 legislation.govt.nz/regulation/public/2019
6 legislation.govt.nz/regulation/public/2019/0088/latest/whole.html#LMS147048
HEALTHY HOMES STANDARDS COMPLIANCE STATEMENT
11

5. Does the 'tolerance' or 'top up'7 allowance for existing heaters apply?
No
Yes If yes, include a brief description on why it applies:
Examples:
> Required heating capacity is 5.7kW and existing heat pump (installed prior to 1 July 2019) has capacity of 3.3kW.
A 2.4KW fixed electric heater with a thermostat to top up to the required amount has been installed.
> Existing (installed before 1 July 2019) woodburner capacity is 11.9kW. This is 82% of the required heating capacity
of 14.5kW.
Alternative pathway to compliance
Note: Questions 2 to 5 above also need to be answered if this section is being completed.
6.
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 20198
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.
7 For an explanation of these allowances, visit: tenancy.govt.nz/healthy-homes/heating-standard
8 legislation.govt.nz/regulation/public/2019/0088/latest/whole.html#LMS167168)
HEALTHY HOMES STANDARDS COMPLIANCE STATEMENT
12

Geothermal heating compliance
Note: Questions 2 to 5 above do not need to be answered if this section is being completed.
7.
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 2019.9
Provide description on why this regulation applies:
RANDOM
TEXT
For the definition of geothermal heating, visit tenancy.govt.nz/healthy-homes/heating-standard.
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. The healthy homes insulation standard builds on the previous requirements so some existing
insulation may need to be topped up or replaced. See our website for more information. 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.
9 legislation.govt.nz/regulation/public/2019/0088/latest/whole.html#LMS167168)
HEALTHY HOMES STANDARDS COMPLIANCE STATEMENT
13

Ceiling 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.
OR
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.
OR
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
14

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.
Example: Bedroom 4 was an extension to the original property and has a skillion ceiling with no
roof space to install insulation.
(C) NO - NONE OF THE PREMISES
> 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:
No
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.
Example: 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.
HEALTHY HOMES STANDARDS COMPLIANCE STATEMENT
15

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.
Example: 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.
Underfloor 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:
Example: Foil insulation is installed in the subfloor and I have the appropriate compliance documents.
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 exemption10. In many cases, existing foil insulation will not meet the healthy homes
insulation standard.
10 See the insulation guidance document at tenancy.govt.nz/healthy-homes/insulation-standard
HEALTHY HOMES STANDARDS COMPLIANCE STATEMENT
16

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.
Example: 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 3 for a professional to access the area to install insulation.
11 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
17

(C) NO - NONE OF THE PREMISES
>
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 applies12.
Example: The property is built on a concrete slab, therefore there is no suspended floor area in which
to install insulation.
>
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).
Example: 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.
Wall 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).
(C) NONE OF THE PREMISES
12 See tenancy.govt.nz/maintenance-and-inspections/insulation/insulation-exceptions for examples of access exceptions that may apply.
HEALTHY HOMES STANDARDS COMPLIANCE STATEMENT
18

(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.
HEALTHY HOMES STANDARDS COMPLIANCE STATEMENT
19

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 area13 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).
(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 exemption14 applies.
Example: 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.
13 For information on how to calculate this, see the ventilation guidance document at tenancy.govt.nz/assets/Uploads/files/healthy-homes-standards-ventilation.pdf
14 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
HEALTHY HOMES STANDARDS COMPLIANCE STATEMENT
20

Ventilation for kitchens and bathrooms
Complete section 2 or 3.
Extractor 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"5. In this case, state below that you are relying on the modified
standard for extractor fans installed before this date.
(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 exempt16:
Example: 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 5% of the kitchen floor area.
These openable windows are still present and functional.
15 Information on performance requirements for extractor fans is available at tenancy.govt.nz/healthy-homes/ventilation-standard
16 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
21

(C) NOT INSTALLED IN ANY ROOMS
›
Provide brief information about why each room is exempt:
Example: 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 5% of the floor area of each respective room.
These openable windows are still present and functional.
Continuous 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 after
1 November 2019 and was part of that original building consent, and continues to meet the requirements
of the building consent.
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.
HEALTHY HOMES STANDARDS COMPLIANCE STATEMENT
22

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?
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.17
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
No
Briefly specify the reason why there is no moisture barrier.
Example: 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.
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.
17 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
23

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?
No
Yes
If yes, have they been blocked off or do you hold written 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.
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 document18 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.
Landlord 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
/
DD
MM
YYYY
18 tenancy.govt.nz/healthy-homes/draught
HEALTHY HOMES STANDARDS COMPLIANCE STATEMENT
24

Tenancy Services
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
Wall/Doors
Lights/Power points
LOUNGE
Floors/FI. Coverings
Windows
Blinds/Curtains
Heater
Wall/Doors
Lights/Power points
Floors/Fl. Coverings
KITCHEN/DINING
Windows
Blinds/Curtains
Cupboards
Sinks/Benches
Oven
Refrigerator
Ventilation system
Wall/Doors
Lights/Power points
Floors/FI. Coverings
Windows
BATHROOM
Blinds/Curtains
Mirror/Cabinet
Bath
Shower
Wash basin
Toilet (WC)
Ventilation system
Wall/Doors
Lights/Power points
LAUNDRY
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/FI. Coverings
Windows
Blinds/Curtains
RESIDENTIAL TENANCY AGREEMENT
25

BEDROOM 4
Wall/Doors
Lights/Power points
Floors/FI. Coverings
Windows
Blinds/Curtains
Rubbish bins
Locks
Garage/Car port
Grounds
No. keys supplied
Insulation
Gutters and downpipes
Ground moisture barrier
GENERAL
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 tenancy.govt.nz/smoke-alarms
List of furniture and chattels
Provided by the landlord
NONE SUPPLIED
Signatures for Property Inspection Report
Do not sign unless you agree to all the details in the
Property Inspection Report
Signed by
LANDLORD
DATE SIGNED
Signed by
TENANT
DATE SIGNED
Rent and Bond Receipt
Initial rent payment
$
General bond
$
Pet bond
$
Total
$
To (name)
Date paid
Water Meter Reading
For use if charging for water
At start of tenancy
Signed as received
RESIDENTIAL TENANCY AGREEMENT 26