Simple Tenancy Agreement

TENANT APPLICATION FORM

RENTAL MANAGEMENT LTD (Harcourts Bell Block)

Address: 12 Pohutukawa Pl, Bell Block | Free Phone: 0508 2 rental (0508 273 682) | Fax: 06 755 0220 | Mobile: 027 579 7665

Email: Aimee.Yee@harcourtsbbk.co.nz | Web: www.aimeeyee.harcourts.co.nz

HOW DID YOU HEAR ABOUT THIS PROPERTY?

Trade Me Newspaper Harcourts Website Rental List Other

A. PROPERTY DETAILS

Address of property applying for:

Preferred lease commencement date:     Preferred lease Term:

Weekly Rent: $    How many tenants will occupy the property?

No. Adults:     No. Children:     Age(s) of children:

Name(s) of joint applicant(s):

Please Note: All intended occupants over the age of 18 years must complete an individual application form

B. PERSONAL DETAILS

Mr Ms Miss Mrs Other

Full Name(s):

Date of Birth:     Age:

Drivers licence number:     Version number (5b):

Current Address:

Home:     Mobile:

Work:     Fax:

Email Address:

C. APPLICATION HISTORY/REFERENCES

Do you currently: Own your own home Rent Board

How long have you lived at your current address? Years: Months:

Why are you leaving this address?

Weekly rent paid: $    Bond Held: $

Name of Landlord/Agent:     Landlord/Agents phone number:

Is your current landlord/agent aware that you are looking for a rental property? Yes No

Can we contact your current landlord/agent for a tenancy reference? Yes No

What was your previous address?

How long did you live at this address? Years: Months:

Name of Landlord/Agent:     Landlord/Agents phone number:

Weekly rent paid: $    Was your bond refunded in full? Yes No

If not please state why not:

If you have written references please attach them to your application. Please note that references from parents/flatmates/friends will not be accepted

D. EMPLOYMENT HISTORY

What is your occupation?

Employers name:     Employers Address:

Contact name:     Contact phone number:

Length of employment:     Gross annual income: $

E. W.I.N.Z

Do you receive a benefit? Yes No

Will your rent be paid direct from WINZ? Yes No

What is your WINZ number?

F. NEXT OF KIN CONTACT DETAILS (please provide a contact in the event of an emergency)

Full Name(s):

Relationship to you:     Contact phone number:

Address for service:

G. MOTOR VEHICLE DETAILS

Make/Model:     Registration number:

Make/Model:     Registration number:

H. PETS (please list details of all pets)

Type/Breed:

I. RENTAL MANAGEMENT LTD (HARCOURTS BELL BLOCK) PRIVACY DISCLOSURE STATEMENT

We are an independently owned and operated business. We are bound by the Privacy Act 1993. We collect 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 landlord or agent, your current employer and your referees. We will also check whether any details of tenancy default by you are held on a tenancy default database operated by T.I.N.Z. Your consent 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 details to service providers relevant to the tenancy relationships including maintenance contractors and landlord’s insurers. We may also send personal information about you to the owners of other properties at your request. You have the right to access personal information that we hold about you by contacting our privacy officer. If you do not complete this for 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.

T.I.N.Z STATEMENT

Tenants please note: By entering into this agreement you agree that your personal details, and an assessment regarding your fulfilment of basic tenant responsibilities (i.e. pay the rent, keep the dwelling and grounds tidy, be considerate of neighbours, leave the dwelling and grounds tidy) may be added to an internet based tenants website, accessible by members (comprising of other property managers and landlords) on a subscription basis. This assessment can only be used for the purpose of evaluating you for future tenancies. Under the Privacy Act 1993 you have the right to see the information held about you by any credit bureau or tenant database, and to correct it in accordance with the Privacy Act. If you wish to view any information held about you, send your request to: Tenancy Information N.Z Ltd, PO Box 105524, Auckland City, New Zealand.

PRIVACY CONSENT

I, the said applicant acknowledge that I have read the Privacy Disclosure Statement of Rental Management Ltd (Harcourts Bell Block). I authorise Rental Management Ltd (Harcourts Bell Block) to collect information about me from:

1. My previous/current letting agent and/or landlord(s)

2. My referees

3. My employer

4. Any tenancy default database (including T.I.N.Z) which may contain personal information about me. I also authorise Rental Management Ltd (Harcourts Bell Block) to disclose details about any defaults made by me under the tenancy to which this application relates to and any default database to which it subscribes including T.I.N.Z.

I authorise Rental Management Ltd (Harcourts Bell Block) to disclose personal information it collects about me to the owner of the property, even if the owner is a resident outside of NZ.

The applicant acknowledges that he/she must pay a letting fee equivalent to one week’s rent plus GST should Rental Management Ltd (Harcourts Bell Block) introduce me to a property. I confirm that all the information given in this form is true and correct.