Application for residential tenancy . . .

Personal Information
Date of Application
Address of property
Expected Move in Date
Rent Amount
First Name
Middle Name
Surname
Home Phone No
Work Phone No
Mobile Phone No
Email Address
Names of all persons wishing to occupy the premises
Date of Birth
Pets Owned
Car make
Registration No
Smoker	Yes          No
Drivers Licence No.
Drivers Licence Version No.
Bank Account No.
Passport No.
Current Tenancy
Present address
Period of occupancy
Rent paid ($)
Reason for leaving
Name of agent or owner
Phone
Previous Tenancy
Previous address
Period of occupancy
Rent paid ($)
Reason for leaving
Name of agent or owner
Phone
Occupation Related Information
Occupation
Income
Name of employer
Employers address
Period of employment
Business Phone
Student	Yes           No
Institution
Course
Welfare no
Second Address for Service (Emergency Contact/Next of Kin)
Name
Phone
Address
Relationship
Name
Phone
Address
Relationship
Declaration
I, the applicant solemnly declare that I am not an undischarged bankrupt.	Yes           No
If you answered no, please give details
Have you ever been evicted by any landlord or agent?	Yes           No
If yes, give details
Are you in debt to another landlord or agent?	Yes           No
If yes, give details
Is there any reason known to you that would affect your rental payment?	Yes           No
If yes, give details
Were any deductions made from your rental bond at your last address?	Yes           No
If yes, give details

Privacy Act Statement (for the purposes of the Privacy Act 1993)

• This application collects personal information about you.
• This information is to be held and used by us, Goodwin Realty Ltd, on a database and also by the property owner.
• This information is collected for:
  • Assessing your eligibility as a tenant, and checking your record on any tenant default database or credit bureau, and
  • Publication on any tenant default database or credit bureau if you have breached any terms of your tenancy agreement or of the Residential Tenancies Act 1986 (the databases and credit bureau hold the names of tenants who have proven debts or Tenancy Tribunal Orders against their names), and
  • Marketing our products and services to you in the future.
• The information collected on this form may be made available to credit bureau or tenant default databases and may be made publicly available, and may also be used to enforce a later Tribunal Order.
• You have the right to access the information we hold and to correct any details which are not correct, and you also have the right to correct the details held by any other database or credit bureau in accordance with the Privacy Act 1993. 

• I / We as applicant (s) authorise the release of any information contained on this form to any tenant default database or credit bureau and I / we authorise you to obtain any information about me / us from any tenancy default database or credit bureau.  I / We also consent to you conducting a credit check on me / us.  I / We consent to your firm retaining my / our email address information on the application form for the purpose of marketing to me / us later.
• Notice To All Applicants:  If you do not provide all the information we require then you may not be considered the best applicant on merit for the property available.  A separate completed application form is required for every person wanting to be a tenant. 

Acceptance 

Should this application proceed following initial inspection; I / We accept the property as it was presented to me / us.  Both its location is suitable and the property met the standard of reasonably clean and tidy on my / our inspection.  I / We agree that I / we understand the purpose of this form and confirm that I / we are making an application to rent a house / flat / apartment. 

Option Fee

I / We agree to pay a sum of money not exceeding one weeks rent as a fee for an option to have the first right of refusal for one day to take the property.  I / We agree that if I / we succeed with a tenancy agreement then the fee for the option will become rent.  If I / we decline to exercise the option then the fee will be forfeited to the landlord or the landlords agent in terms of S.17(4)(a) of the RTA.  Any option is always subject to final approval by the landlord or the landlords agent.  The creation of an option is neither confirmation nor a guarantee that any offer will be made to the applicant.