Tenancy

Residential Tenancy
Agreement
This tenancy agreement has been approved for use by The Office of the Tenancy Tribunal.

HOW TO USE THIS AGREEMENT 9. Landlords must also provide a statement to confirm
they will comply, or already do comply, with the healthy
1. This is a legally binding contract. homes standards. This statement can be combined with
2. All tenancy agreements must be in writing. A separate the healthy homes standards compliance statement,
form of tenancy agreement for use for a Boarding House with one signature.
Tenancy is available on our website. 10. Landlords must include a statement about whether
3. The landlord must provide the tenant with a copy of this the property is insured, and if so, what the excess is.
agreement prior to the commencement of the tenancy. They must also include a statement informing the tenant
If the property is a Unit Titles property, a copy of the that a copy of their insurance policy is available on request.
most recent Body Corporate rules must be attached 11. All rental properties must meet the requirements in
to this agreement. regulations regarding insulation and smoke alarms.
4. This agreement must be completed in full and the 12. Before signing this agreement all parties should carefully
tenant and landlord each keep a copy. read it and seek information from Tenancy Services if
5. The rights and obligations set out in the Residential they are unclear about what they are agreeing to.
Tenancies Act 1986 are implied in every residential tenancy 13. The parties must record their full names correctly.
agreement (see pages 2, 3 and 4 of this agreement for
14. If a bond is paid, a Bond Lodgement Form must also
a brief outline of some of the key provisions of the
be completed.
Residential Tenancies Act 1986).
15. Bonds must be lodged with Tenancy Services within
6. No terms or conditions added to this agreement are valid
23 working days of being paid. This can be done online.
if they are contrary to the Residential Tenancies Act 1986.
16. Parties to tenancy agreements are subject to the
7. Landlords must include a signed statement with any new
provisions of the Privacy Act 2020. Any information
tenancy agreement that covers what insulation a property
provided on this agreement shall not be used or disclosed,
has in the ceilings, floors and walls, including where it is,
without consent, for any purpose other than the
what type and what condition. This information can be
administration of the tenancy or to pursue legal action.
provided in the healthy homes standards compliance
statement included in this agreement (page 8). 17. Letting fees can’t be charged to tenants.
8. From 1 December 2020, most new or renewed tenancy 18. If there is a problem between the tenant and landlord,
agreements must also include specific information and they can’t agree, Tenancy Services can help sort
about the landlord’s current level of compliance with it out. Visit www.tenancy.govt.nz or call us for free
the healthy homes standards. For information on when information on 0800 836 262.
a healthy homes compliance statement is required,
head to this page on our website: www.tenancy.govt.nz/
healthy-homes/compliance-statement

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Tenancy

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. www.tenancy.govt.nz , 0800 TENANCY (0800 836 262)

1. Agreement 5. Landlord’s responsibilities

› Each party should keep a copy of this tenancy agreement. › Provide and maintain the premises in a reasonable
› Changes in the particulars of either party must be notified condition.
to the other party within 10 working days. › Allow the tenant quiet enjoyment of the premises.
› This contract may not be enforceable against a tenant › Comply with all building, health and safety requirements
under the age of 18 (a minor). The Contract and Commercial that apply to the premises.
Law Act 2017 may apply. › Comply with all requirements in respect of smoke alarms
2. Contact details imposed on the landlord by regulations.

› Each party must provide an email address and mobile › Landlords need to have working smoke alarms installed in
phone number if they have them. all their residential rental homes. Any replacement alarms
installed after 1 July 2016 (other than hard-wired systems)
› Each party must supply a physical address for service
need to have long life batteries and a photoelectric sensor.
in New Zealand where notices and other documents
relating to the tenancy will be accepted by them, or on › Pay rates and any insurance taken out by the landlord.
their behalf, even after the tenancy has ended. Tenants › Not seize the tenant’s goods for any reason.
who supply the rental address as their address for service › Inform the tenant if the property is on the market
should update this at the end of the tenancy. Parties may for sale.
also supply an additional address for service which can
› Not interfere with the supply of any services
include a PO Box, email or facsimile.
to the premises.
› If the landlord is going to be out of New Zealand for more
› If the landlord is in breach of these responsibilities,
than 21 days and has to appoint an agent, the landlord
the tenant(s) can apply to the Tenancy Tribunal.
must give the tenant the agent’s name, contact address,
mobile phone number (if any), email address (if any) and › Appoint an agent and notify the tenant and Bond Centre of
address for service. the agent’s details whenever leaving New Zealand for more
than 21 consecutive days.
3. Rent
› Inform the tenant of any changes to the information in the
› Landlords shall not require rent to be paid more than insurance statement within a reasonable time.
2 weeks in advance, nor until rent already paid has been
used up. 6. Tenant’s responsibilities
› 60 days’ written notice must be given for rent increases. › Pay the rent on time.
› Rent shall not be increased within 12 months of the start › Keep the premises reasonably clean and tidy, and notify
of the tenancy or the last rent increase. the landlord as soon as any repairs are needed. You may
not withhold rent if you cannot get repairs done.
› Also for rent to be increased in a fixed-term tenancy,
it must be stated in the tenancy agreement. › Seek information from the Ministry of Business, Innovation
and Employment (0800 83 62 62).
› Receipts must be given immediately if rent is paid in cash.
› Use the premises principally for residential purposes.
4. Bond
› Pay all electricity, gas, telephone, and metered
› A bond is not compulsory, but a landlord may require water charges.
a bond of up to 4 weeks’ rent.
› Replace batteries in smoke alarms as required.
› Bonds must be lodged with the Ministry of Business,
› Not damage or permit damage to the premises,
Innovation and Employment within 23 working days
and to inform the landlord of any damage.
of being paid.
› Not disturb the neighbours or the landlord’s
› Receipts must be given for bond payments.
other tenants.
› If the property is sold, the landlord’s rights with regard
› Not alter the premises without the landlord’s
to the bond pass to the purchaser of the property.
written consent.
› The bond covers any damage or loss to the landlord
› Not use the property for any unlawful purpose.
if the tenant’s obligations are not met, but does not
cover fair wear and tear. › Leave the property clean and tidy, and clear of rubbish
and possessions at the end of the tenancy.

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Tenancy

› At the end of the tenancy, leave all keys and such › Landlords must provide tenants with this insurance
things with the landlord. Leave all chattels supplied information (if requested within a reasonable timeframe)
with the tenancy. and provide updated information within a reasonable
› If a maximum number of occupants is stated in the timeframe if insurance information changes, or (where
tenancy agreement, not exceed that number. they are not the insurance holder) within a reasonable
timeframe of becoming aware of the changes.
7. Rights of entry
› If tenants or their guests damage a rental property as a
The landlord shall enter the premises only: result of careless behaviour, the tenant is liable for the
› with the tenant’s consent at the time of entry cost of the damage up to four weeks’ rent or the insurance
excess (if applicable), whichever is lower. Tenants on
› in an emergency
income-related rents are liable for the cost of the damage
› for necessary maintenance or repairs, compliance up to four weeks’ market rent or the insurance excess
or preparation for compliance with any requirements (if applicable), whichever is lower.
regarding smoke alarms, insulation and healthy homes
› Tenants will be liable for the full cost of damage that they or
standards, from 8 am to 7 pm, after 24 hours’ notice
their guests cause intentionally or that results from an act
› for an inspection of the property or work done by the or omission that constitutes an imprisonable offence.
tenant, from 8 am to 7 pm after 48 hours’ notice
12. Healthy Homes Standards
› with the tenant’s prior consent, to show the premises
to prospective tenants, purchasers, registered valuer From 1 December 2020, landlords must include a statement
or real estate agent doing an appraisal, or other expert in most new and renewed tenancy agreements, which includes
engaged in appraising the premises details of the property’s current level of compliance with
› consent may not be unreasonably withheld but reasonable the healthy homes standards. This requirement is provided
conditions may be imposed in regulations 34-39 of the Residential Tenancies (Healthy
Homes Standards) Regulations 2019.
› to test for contamination, after 48 hours’ notice.
Landlords must include a statement in the tenancy agreement,
8. Subletting and assignment which confirms:
If not expressly prohibited by the landlord, the tenant may › that on and after the commencement of the tenancy, the
sublet or assign with the landlord’s prior written consent. landlord will comply with the healthy homes standards as
Consent may not be unreasonably withheld unless subletting or required by section 45(1)(bb) of the Residential Tenancies
assignment is totally prohibited by this agreement. Act, or
› that the landlord already complies with the healthy homes
9. Locks
standards as required by section 45(1)(bb) of the
Locks can only be changed with the agreement of both Residential Tenancies Act
the tenant and the landlord. They should be provided and
This statement can be combined with the healthy homes
maintained in a secure state by the landlord.
standards compliance statement included in this agreement,
10. Insulation with one signature.
› Landlords must disclose the extent of insulation in 13. Notice to terminate tenancy
their properties in a signed statement as part of any
(NB: This does not apply to fixed-term tenancies. Notice
new tenancy agreement.
requirements for fixed-term tenancies are contained in the
› Landlords must provide ceiling and underfloor insulation main body of this agreement.)
that meets minimum standards unless they meet an
exception. In the case of an exception, the landlord must In all cases, the tenant must give the landlord 21 days’ notice
explain how it applies. in writing.

› Landlords must make all reasonable efforts to obtain The landlord may give 42 days’ notice in writing – and must
the required information. This includes physically looking, state the reason for termination if:
engaging a professional to do an assessment and/or › the landlord has an unconditional agreement to sell the
checking the council building file. premises with vacant possession; or
› This information can be included in the healthy homes › the premises are required as the principal place of
standards compliance statement included in this residence for the owner or any member of that owner’s
agreement as a combined statement. family; or

11. Insurance › the premises are required for an employee of the landlord
and this has been agreed at the start of the tenancy.
› Landlords must disclose whether or not the property
is insured in a statement as part of any new tenancy The tenant can terminate the tenancy with two days’ notice if
agreement, and if so, the excess amount of any relevant the property was an unlawful residential premises at the start
policies. They must also include a statement informing of the tenancy and it is still an unlawful residential premises.
the tenant that a copy of their insurance policy is available This applies to both fixed term and periodic tenancies.
on request. In other cases, the landlord must give 90 days’ notice
in writing.

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14. Termination by Tribunal 15. Mitigation of loss

The landlord may apply to the Tenancy Tribunal for a If one party to the tenancy agreement breaches it, the other
termination order where: party must take all reasonable steps to limit the damage or loss
› the rent is 21 days in arrears arising from the breach.
› the tenant has caused or threatened to cause substantial 16. Unit Title Property
damage to the premises
The landlord must notify the tenant of any variations to body
› the tenant has assaulted, or threatened to assault, corporate rules affecting the premises.
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.
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.

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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 (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

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 (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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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
OR
This tenancy is for a fixed term, ending on the day of 20 .
NB: Fixed-term tenancies automatically become periodic upon expiry of the fixed-term unless either party gives the other written notice of their Intention
not to continue with the tenancy. That notice must be given no more than 90 days, and no less than 21 days, before the end of the fixed-term. If the landlord grants
the tenant a right to renew the fixed-term, they should state this below under Number 4. The tenant may exercise this right by informing the landlord
in writing no less than 21 days before the end of the fixed-term.

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

The tenant shall not assign or sublet the tenancy without the landlord’s written consent.
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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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

› From 27 August 2019, the law requires landlords 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

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.

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Healthy Homes Standards
– current level of compliance
This healthy homes compliance statement is for landlords who can attach it to their own
tenancy agreement.
From 1 December 2020, this statement must be included in most new or renewed tenancy agreements. It isn’t required
if the tenancy is for a fixed term, when the fixed term tenancy ends before the relevant healthy homes compliance date.
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.
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).1 It is necessary to provide both, separately signed, statements.2

ƨ Address 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

The healthy homes compliance date for this tenancy is:  D D M M Y Y Y Y

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.

1 http://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.

TENS 6037 10/20

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. 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:

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.

ƨ Heating standard exemptions

Select one box from three options provided in question 1 about heating standard exemptions, then complete questions 2 to
4 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
www.tenancy.govt.nz/assets/Uploads/files/healthy-homes-standards-heating.pdf

Healthy Homes Standards Compliance Statement 2

  Partial exemption: the rental property is part
of a building and the landlord doesn’t own the EXAMPLES
whole building. Provide specific information below
Partial exemption from the heating standard as
on how this exemption applies to your property. If this
the building Body Corporate rules do not allow
exemption applies you still need to complete the rest
the installation of a heat pump on external walls
of this statement. Landlords will still need to take all
as these are part of the common property. There
reasonable steps to ensure the property complies with
is no mains gas to install a flued gas heater and
the healthy homes standards to the greatest extent woodburners can’t be installed.
reasonably practicable.

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 three methods:
1. the Heating Assessment Tool at tenancy.govt.nz/heating-tool
2. the formula contained in Schedule 2 of the Residential Tenancies (Healthy Homes Standards) Regulations 20195
3. by hiring an experienced heating installer to calculate the requirements using one of the above two methods.

3. 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
   

4. Does the ‘tolerance’ or ‘top up’6 allowance for existing

heaters apply? EXAMPLES
 No
› Required heating capacity is 4.5kW and existing
 Yes If yes, include a brief description on why it applies: heat pump (installed prior to 1 July 2019) has
capacity of 3.3kW. A 1.5kW 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 13.3kW. This is 92% of the required
heating capacity of 14.5kW.

 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.

5 www.legislation.govt.nz/regulation/public/2019
6 For an explanation of these allowances, visit: https://www.tenancy.govt.nz/healthy-homes/heating-standard/

Healthy Homes Standards Compliance Statement 3

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.

ƨ 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)

Healthy Homes Standards Compliance Statement 4

 › (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.

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 EXAMPLE
insulation and that are exempt from this
requirement because it is not reasonably Bedroom 4 was an extension to the original
practicable for a professional to install property and has a skillion ceiling with no
insulation in these areas. roof space to install insulation.

Healthy Homes Standards Compliance Statement 5

 › (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 EXAMPLE
insulation doesn’t meet the requirements
of the insulation standard, and any specific Installation is not reasonably practicable because
the property has a skillion roof throughout and
exemption that applies.
there is not enough space for a professional
installer to access the areas to install insulation.

If ceiling insulation isn’t required because your

premises are exempt, but you are unsure if EXAMPLE
there is any existing insulation, specify why an
exemption applies and include confirmation Insulation information is not provided in the
council building file. The ceiling space is also
that you have taken all reasonable steps to
inaccessible and substantial building work
find information about the existing insulation would be required to gain access. Specifically, in
(if any). Note: cutting an access hatch doesn’t order to access the ceiling space, the roof would
count as substantial building work. need to be lifted. The landlord confirms that all
reasonable steps have been taken to find this
information.

Healthy Homes Standards Compliance Statement 6

ƨ 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 exemption7. In many cases, existing foil insulation will not meet the healthy homes insulation standard.

3. Does the underfloor insulation meet the requirements of the insulation standard?8
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’)

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

8 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 7

 › (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 EXAMPLE
don’t have underfloor insulation and that are
exempt from this requirement because it is not It is not reasonably practicable for a professional
reasonably practicable for a professional to to install underfloor insulation in some areas due
install insulation in these areas. 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.

› (C) NO – NONE OF THE PREMISES

▶ Specify the reason(s) why the underfloor area isn’t
insulated or why the existing insulation doesn’t EXAMPLE
meet the requirements of the insulation standard,
and any specific exemption that applies9. 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 EXAMPLE
if there is any existing insulation, specify why
an exemption applies and include confirmation Insulation information is not available in the
that you have taken all reasonable steps to find council building file. The underfloor space is also
information about the existing insulation (if any). 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.

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

Healthy Homes Standards Compliance Statement 8

ƨ 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. You only need to include this information if it’s known.
› (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

› (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 9

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 area10 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 EXAMPLE
exemption11 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.

10 For information on how to calculate this, see the ventilation guidance document at tenancy.govt.nz/assets/Uploads/files/healthy-homes-standards-ventilation.pdf
11 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 10

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 standard12. 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 EXAMPLE
about why each room is exempt13:
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.

› (C) NOT INSTALLED IN ANY ROOMS

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 5% of the floor area of each respective room.
These openable windows are still present and functional.

 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.

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

13 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 11
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.14
 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 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.

14 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 12

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 document15 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.

ƨ 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  D D M M Y Y Y Y

Healthy Homes Standards Compliance Statement 13

 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
Wall/Doors
Lights/Power points
LOUNGE

Floors/Fl. Coverings
Windows
Blinds/Curtains
Wall/Doors
Lights/Power points
Floors/Fl. Coverings
KITCHEN/DINING

Windows
Blinds/Curtains
Cupboards
Sinks/Benches
Oven
Refrigerator
Wall/Doors
Lights/Power points
Floors/Fl. Coverings
Windows
BATHROOM

Blinds/Curtains
Mirror/Cabinet
Bath
Shower
Wash basin
Toilet (WC)
Wall/Doors
Lights/Power points
Floors/Fl. Coverings
LAUNDRY

Windows
Blinds/Curtains
Washing machine
Wash tub
Wall/Doors
BEDROOM 1

Lights/Power points
Floors/Fl. Coverings
Windows
Blinds/Curtains
Wall/Doors
BEDROOM 2

Lights/Power points
Floors/Fl. Coverings
Windows
Blinds/Curtains
Wall/Doors
BEDROOM 3

Lights/Power points
Floors/Fl. Coverings
Windows
Blinds/Curtains

RTA01 Residential Tenancy Agreement www.tenancy.govt.nz PAGE 21

 Tenancy

Wall/Doors
BEDROOM 4

Lights/Power points
Floors/Fl. Coverings
Windows
Blinds/Curtains
Rubbish bins
Locks
GENERAL

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 $4,000.
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 Signatures for Property

Provided by the landlord 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)

Water Meter Reading Date paid

For use if charging for water

At start of tenancy
Signed as received

TENS 6037 10/20

RTA01 Residential Tenancy Agreement www.tenancy.govt.nz PAGE 22