APPLICATION FOR RENTAL ACCOMODATION

 

Surname_______________________________First names_______________________________________

 

Current Address________________________________________________________How long?_________

 

Previous Address_______________________________________________________How long?_________

 

Present Telephone Numbers: Mobile___________________________Work___________________________

 

Email Address____________________________________________________________________________

 

Number of intended occupants (including applicant): Adults____________Children_____________________

 

Occupation____________________________________Employer___________________________________

 

How long with this employer?____________________

 

If less than two years state previous employer and length of employment____________________________

 

Will you be parking a motor vehicle on the property?     Yes / No      Do you require garaging?      Yes / No

 

Vehicle:  Make / Model_______________________Registration No_________________________________

 

Do you own a pet?     Yes / No          If yes, give details__________________________________________

 

Do you own a service assistance animal eg Guide Dog / Medical assistance Dog    Yes / No____________

 

Are any occupants smokers?   ___________________________________________Yes / No____________

 

Identification:  Date of birth__________________ Drivers License / Passport No_______________________

 

Are you wanting a:  House / Unit / Flat           Amount of Rent (up to) $______________________________

 

Preferred Areas___________________________________________________________________________

 

Previous Renting References________________________________________________________________

 

Landlord Name and Address_____________________________________Telephone___________________

 

                                                    ___________________________________________________________

 

Landlord Name and Address_____________________________________Telephone___________________

                                                   ___________________________________________________________

 

Next of Kin

Name and Address________________________________________________________________________

 

Relationship_____________________________________Telephone________________________________

 

I/We consent that the above information may be used to obtain credit and personal references

 

I/We declare that the information in this form is true and correct and that I have read the Privacy Act 1993

 Statement on the reverse side of this form.

 

 

 

Signature________________________________________Date__________________________________

(If you do not enter into a tenancy agreement this form will be destroyed and we will not retain

 the information you have provided)