Email address*
Proof of Current Address(Suitable proof: Telephone/Power account)
Select
Yes
No
Type of proof
Phone Number (home)*
Phone Number (work)*
Phone Number (mobile)*
Address for Service(NZ street address required for legal documents)
Date of Birth
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Suitable Photo I.D
Please Select
Photo Driver’s Licence
Passport
WINZ I.D
Photo Credit Card
I.D. No
Emergency Contact*
Relationship*
Address
Phone number*
Applicants Accommodation
Present Accommodation
Please Select
Home Owner
Renting
Boarding
Living at Home
New to NZ
Length at this address
Years
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40+
Months
0
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Have you given notice
Please Select
Yes
No
Why are you moving?
Employment / Income
Company you work for?
Period Worked there?
Years
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Contact Name
Phone
Mobile
OR
Are you on a benefit?
Select
Yes
No
Other
Please Specify
Occupants
How many people in total will live at the property?
Adults
Select
1
2
3
4
5+
Children
Select
0
1
2
3
4
5+
Children's Ages
Vehicles
How many vehicles will be parked at the property?
Select
0
1
2
1. Make
Other
Do you Smoke?
Select
Yes
No
Do you have pets?
Select
Yes
No
If 'yes', list details
Rental History
Have you rented before
Select
Yes
No
Referees
1. Name
Company
Phone
2. Name
Company
Phone
How did you hear about us?
Select
Newspaper
Rental List
Internet
‘For Rent’ Sign
Referral from Friend or Family
Other
CONSENT STATEMENT:
I understand and consent that:
You are asking me for personal information about me that you will give to a credit bureau and that the credit bureau will hold that information on their systems and use it to credit check me and to provide their credit reporting service.
When any other credit bureau’s customers use the credit bureau’s credit reporting service, the credit bureau may give the information to those customers.
You may conduct any enquiries or searches to verify the information contained in this application, and to obtain details of my creditworthiness from the owner or agent of my current or previous residence, my personal referees and any record, listing or database available for such purposes including National Tenancy Database and Tenancy Information New Zealand.
You may provide the information in this form and details of any proven breach in my tenancy agreement or of the Residential Tenancies Act 1986 to any credit bureau or tenant default database and that the information may then be publicly accessible through any credit bureau or tenant default database.
Under no circumstances will you accept a Bond Transfer.
If I proceed with renting one of your properties, I do solemnly and sincerely declare and agree that:
I am not a discharged bankrupt, and I am 18 or older.
The rent to be paid is within my means and I will complete a tenancy agreement prepared by the Company.
I am responsible for arranging my own Contents Insurance cover, and for any damage that may be caused to the landlord’s property.
My phone numbers and/or email addresses may be given to trades people to arrange access for maintenance purposes, or to a valuer or agent for the purpose of making a mutually acceptable viewing appointment when a valuation is required.
If I default in my obligations to you, that fact and other relevant personal information collected about me during the course of the tenancy may be disclosed to a credit company and/or the landlord and/or third party operators of the tenancy/reference databases and/or other Real Estate Agents, and those parties may give information about my default to their customers.
Any costs of debt recovery will be my responsibility.
You may use any of the information on this form to enforce any judgment in respect of the tenancy agreement or in respect of any order against me made by the Tenancy Tribunal.
I hereby appoint the Company as my agent to find accommodation for me. Should you introduce me to any premises which lead to me taking a tenancy, I undertake to pay your fee equal to one weeks rent plus GST.
I CONFIRM THE INFORMATION IN THIS FORM IS TRUE AND CORRECT AND THAT I HAVE READ AND UNDERSTOOD ALL OF THE ABOVE INCLUDING THE PRIVACY ACT 1993 STATEMENT AND THE CONSENT STATEMENT.
I authorise that the above information may be used to carry out a credit check on me. I also agree that should I be in breach of any express or implied provision of the tenancy agreement or any provision of the residential Tenancies Act, that I will pay the Landlord's costs's incurred in undertaking collection action to recover his/her losses.