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PROPERTY APPLYING FOR
Address of Property
0 /
Lease start date
Lease period (6 months / 1 year)
PERSONAL DETAILS
Full Name(s)
0 /
Current Address
0 /
Home Phone
0 /
Work Phone
0 /
Mobile
0 /
Drivers Licence Noyour full name
Version (5b on Card)
Date of Birth
Car Registrationyour full name
Car Make
Car Model
NAMES OF OTHER INTENDED OCCUPANTS (INCLUDING CHILDREN)
1. Name
Age
Occupation
Contact Phone
2. Name
Age
Occupation
Contact Phone
3. Name
Age
Occupation
Contact Phone
4. Name
Age
Occupation
Contact Phone
5. Name
Age
Occupation
Contact Phone
ADDRESS FOR SERVICE
Emergency contact in case we cannot find you. Usually a Mother, Brother, Guardian etc.
Full Name(s)
Relationship
Addressyour full name
Phone
Mobile
NEXT OF KIN
Full Name(s)
Relationship
Addressyour full name
Phone
Mobile
CURRENT LEASE DETAILS
Length of time at current address
Rent Paid
Reason for leaving
Name of Landlord / Agent
Phone
PREVIOUS RENTAL HISTORY (if less than 3 years at current address)
Previous Address
Length of time at above address
Rent Paid
Name of Landlord / Agent
Phone
CURRENT OCCUPATION
REFEREES
1st Referee Name
Relationship #1
Phone #1
2nd Referee Name
Relationship #2
Phone #2
PLEASE ANSWER THE FOLLOWING
Have any of your previous tenancies been terminated
Are you in debt to another Lessor or Agent?
Do you or any other intended occupants smoke?
Do you have any pets?
Is there any reason that may affect your rent payment?
Do you have a criminal conviction?
PRIVACY DISCLOSURE STATEMENT OF PREMIER REALTY LTD

We are an independently owned and operated business. We are bound by the Privacy Act 1993. We collect personal information about you in this form to assess your application for a residential tenancy. We may need to collect information about you from your previous landlords or letting agents, your current employer, credit agencies and your referees. By proceeding this you are consenting to us collecting this information is set out below. We may disclose personal information about you to the owner of the property to which this application relates. If this application is successful we may disclose your contact details to maintenance contractors and the landlord’s insurers. We may also send personal information about you to the owners of any other properties at your request. You have the right to access personal information that we hold about you by contacting our office. If you do not complete this form or do not sign the consent below then your application for a residential tenancy may not be considered by the owner of the relevant property or, if considered, may be rejected.

PRIVACY CONSENT

I the Applicant acknowledge that I have read the privacy statement of Premier Realty Ltd. I authorise Premier Realty Ltd to collect information about me from: 1. My previous letting agents and/or landlords, 2. My referees, 3. Any tenancy Default Database which may contain personal information about me. I also authorise Premier Realty Ltd to disclose details about any defaults by me under the tenancy to which this application relates to any tenancy default database to which it subscribes including Department of Housing and Building National Tenancy Database (NTD). I authorise Premier Realty Ltd to disclose the personal information it collects about me to the owner of the property even if the owner is resident outside New Zealand and to any third parties contractors, valuers, salesperson, insurance companies, body corporates, trustees, other agents and tenancy default databases.

CREDIT REPORT PRIVACY CONSENT

I the Applicant understand that you Premier Realty Ltd are asking me for personal information about me so as to use Tenancy Information New Zealand (TINZ) credit reporting service to credit check me. I understand that; 1. TINZ will give you information about me for that purpose. 2. You will give my personal information to TINZ; and that TINZ will hold that information on their systems and use it to provide their credit reporting service. 3. When other TINZ customers use TINZ credit reporting service, TINZ may give the information to those customers. 4. You may use TINZ credit reporting services in the future for purposes relating to the provision of credit to me. This may include using TINZ monitoring services to receive updates if any of the information held about me changes. 5. If I default in any payment obligations to you, information about that default maybe given to TINZ and TINZ may give information about my default to other TINZ customers.

DECLARATION

I hereby offer to rent the property from Premier Realty Ltd.

I acknowledge that I will be required to pay the following amounts

First payment of one weeks rent in advance, $
Rental Bond (equivalent to four weeks rent), $
Tenant Letting Fee (equivalent to one weeks rent plus GST), $
Total amount payable on signing Tenancy Agreement, $
ACKNOWLEDGEMENT

I acknowledge that this application is subject to the approval of the property owner. I declare that all information contained in this application is true and correct and given of my own free will.

I declare that I have inspected the premises and am satisfied with the current condition and cleanliness of the property.

APPLICATION SUBJECT TO CONSENT

Processing of this application will not commence unless all sections have been completed and relevant documentation provided at the time of submission of the application to Premier Realty Ltd.

Please tick yes to confirm all the above details are true and correct
Your full name
Date
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