Rental Property Address * Applicant Details Full Name * Date of Birth * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year19241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Mobile Phone * Home Phone Email * Applicant address * Time at current address * Reason for leaving * Emergency contact * Next of kin (provide name and address) * Have you had a previous tenancy terminated? * Yes No Please provide details Have you ever had money deducted from your bond? * Yes No Please provide details Are you currently paying off a debt to any finance companies? * Yes No Please provide details Are you currently paying off a debt to any other landlord or property manager? * Yes No Please provide details Number of people intending to reside (including applicant) * Name and age of other residents Identification Drivers Licence Number Licence Version Other form of ID Motor Vehicles Will you be parking a motor vehicle on the property? * Yes No Please provide details How many? Who is the registered owner? Other details such as make/model/colour/registration number. Pets and Smokers Do you have any pets? * Yes No What is the pet? (include breed and size) Are you or any other prospective occupant, a smoker? * Yes No Income and Employment What is your source of income? * Employment Self Employment WINZ, Benefit, or StudyLink Income per week WINZ number Employer Address Manager's name Phone number Term of employment References Please supply two character referees who agree to be contacted. Name of first reference Phone of first reference Name of second reference Phone of second reference Please supply details for your current landlord for a reference. Current landlord name Current landlord phone Previous landlord name Previous landlord phone Address of previous property rented Terms & Conditions I have read and accept the terms and conditions. Term and Conditions * I Agree Leave this field blank Submit