This form may be used by an “impacted lessee” (as defined by the Retail and Other Commercial Leases (COVID-19) Regulation 2020 (NSW)) to request a change to

their current rental payments. Please add your own branding if required.

Rental Payment Proposal During Coronavirus (COVID-19) Pandemic The Lessee(s) is submitting this proposal to the Lessor in relation to the rent because the Lessee is an “impacted lessee”, as defined in the Retail and Other Commercial Leases (COVID-19) Regulation 2020 (NSW) (“Regulation”), as a direct result of the impact and commercial disruption caused by the COVID-19 pandemic.

Name of lessor(s) (“the Lessor”):Name of lessee(s) (“the Lessee”):Lessee(s) business name(s):Details:eg ABC Pty Ltd trading as ABC, ABN/ACN

Address of leased property:

Proposal

Existing rent as per lease (per week):

Date of last rent paid: Amount of last rent paid:Arrears breakdown:Details of when the arrears arose

Rent proposal to Lessor: Waivers:

(a) amount(b) proposed start date(c) proposed end date

Deferrals:

(a) amount(b) proposed start date(c) proposed end date

Payment of Deferrals:To commence:To finish:

Extension of Lease:(if relevant)

Reason for request/proposal:

Background to Proposal

Nature of the business that is being undertaken at the premises and the subject of the lease (“Business”)Details:

Does the Lessee also conduct the business from any other premises?Details:

Yes ☐ No ☐

Is the Lessee part of a group?

Note: Corporations constitute a “group” if they are related bodies corporate within the meaning of the Corporations Act 2001 (Cth)

Yes ☐ No ☐

Does the Lessee have a parent company?Details:

Yes ☐ No ☐

Is the Lessee or any parent company listed on a stock exchange eg Australian Stock Exchange?Details:

Yes ☐ No ☐

Is the Business still trading?Details:

If so, is it open for business during the hours specified in the lease?Details:

Yes ☐ No ☐

Yes ☐ No ☐

In the 2018-2019 financial year, was the following turnover less than $50 million:

(i) if the Lessee is a franchisee – the turnover of the business conducted at the premises or land concerned;

(ii) if the Lessee is a corporation that is a member of a

Yes ☐ No ☐

Yes ☐ No ☐

group – the turnover of the group; or

(iii) in any other case – the turnover of the business conducted by the Lessee?

Note: The turnover of the Business includes any turnover derived from internet sales of goods or services.

Yes ☐ No ☐

Has the Business’s turnover decreased?Details:

Turnover prior to the COVID-19 pandemic:Current turnover:Turnover compared to previous 12 months:

Yes ☐ No ☐

Has business profitability been affected?Details:

Yes ☐ No ☐

Does the Lessee qualify for the Australian Government’s JobKeeper scheme?

Yes ☐ No ☐

If the Lessee qualifies for the JobKeeper scheme, has the Lessee lodged an application for the scheme??Details:

Yes ☐ No ☐N/A ☐

Has that application been accepted? Yes ☐ No ☐N/A ☐

Has that application been rejected?Details:

Yes ☐ No ☐N/A ☐

Is the Lessee eligible for any form of Government assistance being offered in response to the COVID-19 pandemic?Details:

Yes ☐ No ☐

Has the Lessee applied for or received any State or Federal assistance since 1 March 2020?Details:

Yes ☐ No ☐

Has the Lessee recently obtained any financial management advice for the Business from a suitably qualified person?Details:

Yes ☐ No ☐

Has the Lessee received advice from its financial institution in relation to assistance they can provide (such as overdraft facilities, business loan deferral options, etc)?Details:

Yes ☐ No ☐

Has the Lessee developed a business plan or future cash plans to deal with the COVID-19 pandemic with specific regard to its turnover, expenses and profitability?

Details:

Yes ☐ No ☐

Have you claimed or are you entitled to claim any insurance (such as income protection or business continuation/interruption

Yes ☐ No ☐

loss) which may respond in the circumstances?Details:

Other information of which the Lessor should be made aware by you:

So that the Lessee’s proposal can be properly considered by the Lessor, it is recommended that the Lessee act in an open, honest and transparent manner and to attach sufficient and accurate supporting documentary evidence to achieve outcomes consistent with the Regulation and the National Cabinet Mandatory Code of Conduct - SME Commercial Leasing Principles During COVID-19 (“Code”). Please refer to the list at the end of this form for examples on the supporting evidence Lessee’s may provide.The Code requires that any agreed arrangements take into account the impact of the COVID-19 pandemic on the Lessee, with specific regard to its revenue, expenses and profitability. The supporting documents provided by the Lessee must enable the Lessor to make a proper and informed assessment of the impact of the COVID-19 pandemic on the Lessee, including with regard to its revenue, expenses and profitability.

Confidentiality and Privacy:This proposal will be treated confidentially by the Lessor’s real estate agent, the Lessor and their/its advisers.

By providing this information and documentation, the Lessee acknowledges and authorises that this material may be passed on to third parties, including, but not limited to, the Lessor and their/its legal and financial advisers, banks, mortgagee(s), insurers and Government and State Government agencies.

Acknowledgements:By submitting this proposal, the Lessee also acknowledges that any decision in relation to the rent arrangement is made by the Lessor and not the Lessor’s real estate agent or property manager.

Any agreement made between the Lessor and the Lessee remains in place for the agreed time or, if the parties cannot agree, as stipulated in the Regulation, and is subjected to any legislation relevant to the COVID-19 epidemic.

Any negotiations and subsequent enactment of temporary arrangements by the Lessor is conditional upon the information provided by the Lessee being true and correct.

If the financial circumstances of the Lessee or its Business change, the Lessee will immediately report this to [insert name of agency] and a new proposal must be submitted for consideration.

Lessee’s Signature

I agree to be legally bound by the terms of this document even if I sign this document electronically.

Signature: Full Name:Date:

I agree to be legally bound by the terms of this document even if I sign this document electronically.

Signature:Full Name: Date:

Supporting Documents Provided by Lessee Supplied

1.

Evidence that the company is a small and medium-sized enterprise (SME) with a current turnover of less than $50 million per annum (eg. statutory declaration signed by directors)

Yes ☐ No ☐

2. Evidence that the Business’ revenue, expenses and profitability has been affected due to the COVID-19 pandemic including but not limited to business activity statement reports, financial statements and or management accounts (and intra-group transactions if part of a GST Group) outlining the Business’ profits, losses, assets and liabilities for the past 2 years (including the March 2020 period). Note: These documents must be prepared by a qualified accountant

Yes ☐ No ☐

3. Evidence of eligibility for the Australian Government’s JobKeeper scheme

Yes ☐ No ☐

4. Evidence that the Business has applied for the Australian Government’s JobKeeper scheme

Yes ☐ No ☐

5. Evidence that the Business has been accepted for the Australian Government’s JobKeeper scheme

Yes ☐ No ☐

6. Evidence provided by a tax agent, accountant and/or financial adviser that the Business’ capacity to make rental payments has been significantly reduced due to the impact of the COVID-19 pandemic

Yes ☐ No ☐

7. Evidence that the Business has reduced staff hours, terminated staff employment contracts and/or implemented other arrangements to mitigate its losses stemming from the COVID-19 pandemic

Yes ☐ No ☐

8. Evidence of loss of clients or projects Yes ☐ No ☐

9. Evidence of anticipated turnover loss for the current quarter and beyond

Yes ☐ No ☐

10. Completed “Rental Payment Proposal Form” (ie. this form) Yes ☐ No ☐

11. Other relevant evidence or information to allow the Lessor to properly assess your rent assistance request which demonstrates how the Business’ circumstances have changed due to the COVID-19 pandemic

Yes ☐ No ☐