Residential Tenancy Application Form All sections of this form must be completed & signed for your application

ed & signed for your application to be processed.

Proposed Rental Property Address: Postcode:

Rent Per Week: $ Bond Amount: $ Have you inspected the property?: YES / NO (Please circle)

Length of Tenancy: Years: Months: Tenancy to Commence:

Pets: Yes / No (Circle)
How many tenants will occupy the property? Adults: Dependants: Ages: If yes attach a PHOTO OF EACH pet.
Pet Type: Breed/s: Reg. No: Outdoor only: YES / NO
Pet Type: Breed/s: Reg. No: Outdoor only: YES / NO

Vehicle 1 Rego: Model/Year/Colour: Vehicle 2 Rego: Model/Year /Colour:

1. First Applicant 1. Second Applicant AND/OR Partner

Title: First Name: Middle Initial: Title: First Name: Middle Initial:

Last Name: Smoker: Yes / No Last Name: Smoker: Yes / No

Name at Birth: Country of Birth: Name at Birth: Country of Birth:

Date of Birth: / / Age (Years / Months): Date of Birth: / / Age (Years / Months):

Drivers Licence No: State: Drivers Licence No: State:

Card No. (NSW only): Card No. (NSW only):

Passport No: Medicare No: Ref: Passport No: Medicare No: Ref:

Pension Type (If applicable): No: Pension Type (If applicable): No:

Home Phone: Mobile Phone: Home Phone: Mobile Phone:

Email: Email:

Marital status: Single Married De Facto Sep/Div Friends Relatives Marital status: Single Married De Facto Sep/Div Friends Relatives

Maiden Name (If applicable): Maiden Name (If applicable):

2. Rental History - Applicant 1 2. Rental History - Applicant 2

Current Address: Current Address:

Suburb: Postcode: Suburb: Postcode:

How long at current address? Years: Months: How long at current address? Years: Months:

Reason for Leaving: Rent per week: $ Reason for Leaving: Rent per week: $

Landlord/Agent Name: Phone: Landlord/Agent Name: Phone:

Email: Fax: Email: Fax:

Previous Address: Previous Address:

Suburb: Postcode: Suburb: Postcode:

Length at previous address? Years: Months: Length at previous address? Years: Months:

Reason for Leaving: Rent per week: $ Reason for Leaving: Rent per week: $

Landlord/Agent Name: Phone: Landlord/Agent Name: Phone:

Email: Fax: Email: Fax:

Bond refunded: Yes / No If not, why?: Bond refunded: Yes / No If not, why?:

3. Employment Details - Applicant 1 3. Employment Details - Applicant 2

Occupation: Employers Name: Occupation: Employers Name:

Employment Address: Employment Address:

Suburb: Postcode: Suburb: Postcode:

Employer Phone No: Contact Name: Employer Phone No: Contact Name:

Length at current employment Years: Months: Length at current employment Years: Months:

Net Income $ Per Week $ Per Month $ Net Income $ Per Week $ Per Month $

Are you self-employed? Yes / No ABN: Are you self-employed? Yes / No ABN:

Accountant Name: Phone: Accountant Name: Phone:

 4. Social Security Benefits OR Centrelink Payment 4. Social Security Benefits OR Centrelink Payment
Type: CRN: Type: CRN:
$ Per Week $ Per Month $ Per Week $ Per Month

5. Referees - Applicant 1 - (NOT co-applicant) 5. Referees - Applicant 2 - (NOT co-applicant)

1. Reference Name: 1. Reference Name:

Address: Address:

Home Phone: Mobile No: Home Phone: Mobile No:

2. Reference Name: 2. Reference Name:

Address: Address:

Home Phone: Mobile No: Home Phone: Mobile No:

6. Emergency Contact Details - (Not same as co-applicant) 6. Emergency Contact Details - (Not same as co-applicant)
Name: Phone No: Name: Phone No:
Address: Address:
Suburb: Postcode: Suburb: Postcode:
Email: Email:

7. Please ensure you provide Min.100 points Identification - at least ONE item from EACH section is required - Photo copy ALL & bring originals
Section 1: Section 2: Section 3:
____ (30) Previous tenancy reference ____ (10) Gas account
____ (40) Drivers License ____ (30) Latest 3 Current Pay Slips OR ____ (20) Previous two rent receipts ____ (10) Pet rego papers
____ (40) Passport (Complete the following) ____ (20) Home owner MUST SUPPLY ____ (10) Birth certificate
Current Bank Statement OR a recent rates notice
Name at Birth: ___________________________ ____ (10) Medicare card
Centre Link income Statement
Place of Birth: ___________________________ ____ (10) Motor vehicle registration
Passport Country: ________________________ ____ (10) Telephone account
____ TOTAL POINTS
____ (10) Electricity account
8. FREE Utilities Connections User Consent Form ReduceMyBills is the hassle-free connections service that takes the time and worry out of moving

Ph: 1300 680 603 • Internet • Foxtel • Telephone • Electricity • Gas

I/we understand that in the course of connecting utilities, ReduceMyBills may
Declaration need to obtain an NMI (National Meter Identifier) for electrical points or MIRN
By signing this application, I/we give consent to ReduceMyBills to make (Meter Installation Registration Number) for Natural Gas connections. I/we
contact by phone, email or sms for the purpose of arranging connections and authorise ReduceMyBills to collect these identifiers and consent to those
disconnections of approved utility services. I/we authorise ReduceMyBills to numbers being supplied to utility providers.
supply collected information to other household service providers for the I/We acknowledge that whilst ReduceMyBills is a free service, I/we are solely
services including Cleaning, Removal, Insurance and Appliances. responsible for any and all amounts payable in relation to deposits, connections/
I/we authorise ReduceMyBills to contact us via these means even if the disconnections or ongoing supply of the connected services and amounts payable
telephone numbers supplied are listed on the Do Not Call Register. I/we for other services including appliance, removalists, cleaners and insurance.
understand that ReduceMyBills may also send related emails promoting I/we acknowledge that ReduceMyBills, to the extent permitted by law, shall not be
other services provided by ReduceMyBills. liable for any loss or damage (including consequential loss and loss of profits) to
I/we acknowledge that all information supplied in the application is true and me/us as a result of the provision of any service. Nor shall ReduceMyBills be liable
correct to be best of my/our knowledge and that we have not falsely for any act or omission by any utility provider for any loss caused by failure to
represented our identity in any manner. provide nominated services.
I/we understand that ReduceMyBills treat any personal information it collects, I/we acknowledge that the nominated real estate entity along with ReduceMyBills
uses or discloses in accordance with the Privacy Act 1988. may receive a benefit from suppliers for the provision of connections.
I/We authorise ReduceMyBills to supply collected information to nominated I/we declare that we have read and understand the above
suppliers and/or potential suppliers for the connection and disconnection of
nominated utilities or to assist with my obtaining other services including
declaration and wish to be contacted by ReduceMyBills.
appliances, removalists, cleaners and insurance. Signature: Date:
9. Declaration of Authority
I hereby offer to rent the property from the owner under a lease to be prepared by the I am aware that if information is not provided or I do not
Agent. Should this application be accepted by the landlord I agree to enter into a consent to the uses to which personal information is put, the
Residential Tenancy Agreement. Agent cannot provide me with the lease/tenancy of the
I acknowledge that this application is subject to the approval of the owner/landlord. I premises.
declare that all information contained in this application (including the reverse side) is
true and correct and given of my own free will. I declare that I have inspected the
premises and am not bankrupt.
Printed Name Applicant 1:
I authorise the Agent to obtain personal Information from:
(a) The owner or the Agent of my current or previous residence; Signature Applicant 1: Date:
(b) My personal referees and employer/s;
(c) Any record listing or database of defaults by tenants such as NTD, TICA or TRA for
the purpose of checking my tenancy history; Printed Name Applicant 2:
I am aware that I may access my personal information by contacting -
• NTD: 1300 563 826 • TRA: (02) 9363 9244 • TICA: 1902 220 346 Signature Applicant 2: Date:
If I default under a rental agreement, I agree that the Agent may disclose details of any
such default to a tenancy default database, and to agents/landlords of properties I may 10. Payment Details Property
apply for in the future.
I am aware that the Agent will use and disclose my personal information in order to: Property Rental Per Week $
(a) communicate with the owner and select a tenant
Rent in Advance ( ___ weeks) $
(b) prepare lease/tenancy documents
(c) allow tradespeople or equivalent organisations to contact me
(d) lodge/claim/transfer to/from a Bond Authority Rental Bond ( ___ weeks rent) $
(e) refer to Tribunals/Courts & Statutory Authorities (where applicable)
Total Due $
(f) refer to collection agents/lawyers (where applicable)
(g) conduct an ID/background check with NTD for residential tenancies and/or a credit
check for commercial tenancies with the National Tenancy Database (NTD) Cheque / Bank Cheque / EZIRENT