Pre-Tenancy Application Form

Address of Property applying for:

Weekly Rent in $:

Required Commencement Date:

Type of Tenancy:
PeriodicFixed Term

Length of Tenancy:
6 months12 monthsother

Number of people to occupy the Property?

No.Adults:

No.Children:

Age(s) Children:

Are any potential occupants smokers?
YesNo

Name(s) of people applying for the property with you:

Full Name:

Date of Birth:

Have you been known by any other name?
YesNo

If yes, what other name are you known by:

Daytime contact number:

Mobile contact number:

Email Address:

Current Address:

How long have you lived there?

Please state why you are leaving this address:

Please provide photo identification, such as Drivers Licence or Passport:

Licence No:

Version No.(5b):

Car/vehicle registration number:

Make and model:

Passport No.

Alternative form of ID:

Full Name:

Relationship to you?

Home contact number:

Mobile contact number:

Email address:

Address for Service:

Have you ever had any Tenancy Tribunal Orders against you?
YesNo

If yes, please state details:

Are you currently:
RentingBoardingFlattingHome ownerother
Other

Weekly rent paid currently in $:

Bond held in $:

We reserve the right not to accept Bond Transfers

Name of Landlord/Agent:

Landlord/Agent phone number:

Is your landlord/agent aware that you are looking for a rental property:
YesNo

Can we make contact with your current Landlord/Agent for a Tenancy reference:
YesNo

What was your prior address to you current address:

How long have you lived there?

Were you previously:
RentingBoardingFlattingHome ownerOther
Other

Name of Landlord/Agent:

Landlord/Agents phone number:

Weekly rent paid in $:

Was your Bond refunded in full?
YesNo

If not please state why:

Source of income:
Full-time employmentSelf-employmentContractWinzOther
Other:

What is your occupation?

Employers Name:

Employers address:

Contact person:

Contact number:

Length of employment:

Weekly/Monthly income in $:

Do you recieve a benefit?
YesNo

Will your rent be paid directly from Winz?
YesNo

What is your Winz number?

Do you have any Pets?
YesNo

If yes what pets do you have?

List Type/Breed, Age, Sex, Registration No of your Pets:

Have you rented a property with your pet(s) before?
YesNo

Do you have references for your pet(s)?
YesNo

Have you had complaints in regards to your pets?
YesNo

If yes, please give details?

Referee 1 Name:

Referee 1 contact number:

Referee 1 email address:

Referee 2 Name:

Referee 2 contact number:

Referee 2 email address:

I authorise the Landlord/Property Manager to:

• collect, retain and use this information for the purpose of assessing my credit worthiness and suitability for the tenancy; and
• disclose information about me, whether collected for me directly or from any other source, to any other credit provider and any credit agency for the purposes of providing or obtaining a credit report(which will involve the
  credit reporting agency providing information about me to the Landlord/Property Manager). This information may be relayed to the Owner of the property in the tenancy decision making process.

I understand that the credit reporting agency;

• may hold my information on their credit reporting database and use it for providing credit reporting services, and
  they may disclose my information to their subscribers for the purpose of credit checking or debt collection; and
• As part of providing a credit report, may check the Ministry of Justice fines, Tenancy Tribunal database and TINZ
  for any overdue fines or orders I may have.

LETTING FEE: 1, the said applicant acknowledges that they must pay a Letting Fee equivalent to one week’s rent plus GST should they be successful in securing a property.

Full Name:

Signature:

Date:

Under the Privacy Act 19193, you have the right to ask for a copy of all information held about you, and have the right to request the correction of any incorrect information.