Tenancy

Application
Form

LJ Hooker Roma

74 McDowall Street
Roma QLD 4455

t 07 4622 1222
f 07 4622 3927
e reception.roma@ljhooker.com.au
Tenancy Application

Applicant’s Name: SHASHANK ANAND MISHRA

Property Address: 1/16 DUKE STREET, ROMA, QLD, 4455

PLEASE NOTE The properties managed by this office may be protected by professional asset management
& debt collection services

PROPOSED PROPERTY:
Address: 1/16 DUKE STREET, ROMA, QLD, 4455

Rent p/w: $260 Preferred Length of Tenancy: 6mth / 12mth

Other: Preferred Start Date: 01-FEB-24

APPLICANTS DETAILS:

(All persons 18+ are required to complete a separate application)

Full Name: SHASHANK ANAND MISHRA
Previous family/last name (if applicable):
Date of Birth: 06-JUL-88 Marital Status: MARRIED
Drivers License No: UP80 20180026356 State: INDIAN DRIVING LICENCE
Passport No: N1759992 Country: INDIA
Visa No: 0039531994864 18+ Card No: Medicare No:
Your Current Address: 6, HANLY STREET, ROMA, QLD, 4455
Home Ph: Mobile: 0408636892
Work Ph: Email: shashank.anand.mishra@gmail.com
How many people will be residing at the property? 2
Adults Names: SHASHANK ANAND MISHRA, NOUSHEEN RAVIPRAKASH DEO
Childrens Names & Ages:

Do you have any pets? Yes / No - Breed & Age:

Vehicle Rego No: State:
No. of cars/bikes to be parked on the premises: Cars Bikes
Make, Model & Colour:
Are you or any of the dependents residing with you, smokers? Yes / No

EMPLOYMENT DETAILS

Occupation: ENGINEER
Full Time / Part Time / Casual / Contract / Self Employed / Unemployed Current Employer
Company Name: EXPRO GROUP
Contact Person: MATTHEW JAY
Their Position:OPERATIONS COORDINATOR
Phone Number: 0460540727
Email: matthew.jay@expro.com
Length of Employment: 6 months
Position held: ENGINEER
Net Weekly Income (excl. over time): $ $1900 approx
Annual Salary: $100,000
Tenancy Application

Previous Employer (complete if current employment is less than 6 months)

Company Name: SGS GULF LTD
Contact Person: NIRAJ KUMAR Their Position: FIELD SERVICE MANAGER
Address: Agility PJSC -Plot #1, Mussafah Industrial Area, Abu Dhabi, UAE.
Phone No: +971-565488077 Email: niraj.kumar@sgs.com
Length of Employment: 6 YRS Position held: GENERAL FIELD ENGNEER

If you are Self Employed

Registered name of business:
ABN: Type of business:
Address:
Phone No: Email:
Length of time in business:
List one major creditor:

If you are a Student

Are you: Full Time / Part Time
Are you an overseas student? Yes / No - Visa expiry date:
Name of learning institution:
Department: Student union no:
Student ID no: Income source:
Contact: Net weekly income: $

If you receive a Centrelink Payment

Total amount received weekly (total payments): $

Type of payment: CRN No:

Copy of Card attached: Yes / No

YOUR RENTAL HISTORY:

Current Agent/Landlord: COMPANY LEASED Phone:
Address of rented property: 6, HANLY STREET, ROMA, QLD, 4455
Date vacated or vacating: Period of tenancy:
Rent per week: $ Reason for leaving:
Was bond refunded in full? Yes / No
If no, why?

Emergency Contact (not residing with you)

Name: RON TAYLOR
Relationship: OPERATIONS MANAGER
Phone: 0411865779
Address: 37, RAGLAN STREET, ROMA, QLD, 4455
Tenancy Application

COST OF STARTING A TENANCY

Bond + 2 weeks’ rent (total 6 weeks’ rent) must be paid to our office prior to moving into a
property. Keys will not be handed over until payment has been made or proof of payment can
be shown.

PAYMENT METHODS
- Cash, paid to our office
- Direct deposit/transfer (bank details will be provided on approval)
- Eftpos NOT available.

100 POINTS OF IDENTIFICATION

Before any application will be considered, you must achieve a minimum of 100 points.

MUST SUPPLY
*DRIVERS LICENCE *30 Points
*WAGES / PAY SLIPS *15 Points
*BANK or CREDIT CARD STATEMENTS *15 Points
PASSPORT 30 Points
PROOF OF AGE CARD 30 Points
TENANCY LEDGER 20 Points
PREVIOUS TENANCY AGREEMENT 20 Points
PREVIOUS FOUR RENT RECEIPTS 20 Points
RENTAL BOND RECEIPT 20 Points
MOTOR VEHICLE REGISTRATION 15 Points
TELEPHONE ACCOUNT 15 Points
ELECTRICITY ACCOUNT 15 Points
GAS ACCOUNT 15 Points
PENSION CARD 15 Points
COUNCIL or WATER RATES 15 Points
HEALTH CARE CARD 15 Points
MEDICARE CARD 10 Points
BIRTH CERTIFICATE 10 Points

TOTAL POINTS PROVIDED

PROOF OF INCOME
If employed - last 2 x pay slips
If self-employed - banks statement; accountants’ details; tax return for previous year.
If unemployed or on benefits - copy of current Centrelink statement and health care card.
Tenancy Application

Privacy Disclosure & Disclaimer Authority:

This form provides information about how we use your personal information, as required by the Australian Privacy Principles in the
Privacy Act 1988, and seeks your consent to disclosures to the TICA Group of companies (TICA) in specified circumstances. If you do
not consent to the disclosure of your personal information to TICA we cannot process your application. As a professional asset
manager, we collect personal information about you. The information we collect can be accessed by you by contacting our office.
Primary Purpose:
Before a tenancy is accepted, we collect your information to assess the risk to our clients in providing you with a property you have
requested to rent and if considered acceptable provide you with a tenancy for the property. In order to assess your application, we
disclose your personal information to:
The Lessor / Owners for approval or rejection of your application, TICA Default Tenancy Control Pty Ltd and TICA Assist Pty Ltd to
assess the risk to our clients and verify the details provided in your tenancy application, any other persons to validate information
supplied in your application and Other Real Estate Agents to assess the risk to our clients.
Secondary Purpose:
During and after the tenancy we may disclose your personal information to: Trades people to contact you for repairs and
maintenance of the property, Tribunals or Courts having jurisdiction seeking orders or remedies, Debt Collection Agencies and
affiliated industries, TICA Default Tenancy Control Pty Ltd to record details of your tenancy history, Lessors / Owners insurer in the event
of an insurance claim and Future rental references to other asset managers / owners.
TICA Statement:
As the TICA Group may collect personal information about you, the following information about the TICA Group is provided in
accordance with the Australian Privacy Principles in the Privacy Act 1988. TICA Default Tenancy Control Pty Ltd (ABN 84 087 400 379)
is a tenancy database that records tenant’s personal information from its members including tenancy application inquiries and
tenancy history. TICA Assist Pty Ltd (ABN 28137 488 503) is a database company that records information from mercantile agents
and associated industries. In accordance with the Australian Privacy Principles, you are entitled to have access to any personal
information that we may hold on any of our databases. To obtain your information from the TICA Group proof of identity will be
required and can be made by mail to: TICA Public Inquiries PO BOX 120, CONCORD NSW 2137 a fee will apply
TICA Primary Purpose:
The TICA Group collects information from its members and provides such information to other members as a risk management
system for the purpose of assessing a tenancy application. The TICA Group does not provide any information that it collects to any
other individual or organization other than its own group of companies for any other purpose other than assessing a tenancy
application or risk management system or locating system other than government departments and or agencies allowed by law to
obtain information from the TICA Group. The personal information that the TICA Group may hold is as follows:
Name, date of birth, drivers license number, proof of age card number and or passport number (except Australian) and address
at time of making a tenancy application, comments made by a TICA member in relation to your tenancy, which members you
rented through and which members you applied to and which members are seeking you.

I SHASHANK ANAND MISHRA, the said applicant, do solemnly and sincerely declare that the information contained in this application is
true and correct and that all

of the information was given of my own free will. I further consent to the lessor/agent contacting and /or conducting any enquiries
and/or searches with regard to the information and references supplies in this application.
I, the said applicant, do solemnly and sincerely declare that I am over 18 years of age and have read and understand the contents of
this agreement and have the competence and capacity to enter into this agreement.

Applicants Full Name: SHASHANK ANAND MISHRA

Signature: Date: 17-JAN-24