Tenancy Application Form

1Tenancy Details

2Applicant Details

3Applicant Renting History

4Emergency Contact

5Current Employment Details

6References

7Signature

Unit/Address of Property you wish to rent:*
Proposed Commencement Date of Tenancy*
DD slash MM slash YYYY
Preferred type of Tenancy*
- Fixed Term
- Periodic
Proposed Length of Tenancy (months)*
How did you find out about this property?*
- TradeMe
- Website
- Social Media - Twitter/Facebook
- Referred
- Other
This is a petfree and smokefree building. Please tick to show you have read and understand this.*

Applicant's Name*
First name (as shown on your Photo ID) Last name (as shown on your Photo ID)
Applicant's Date of Birth:*
Applicant's Mobile*
Applicant's Email*
Are you a New Zealand Citizen or permanent resident?*
- Yes
- No
Drivers License No.:*

Please use your NZ drivers license for ID if you have one
License Version No.:*

The version number is shown on section 5b of your license.
Car Registration No:*
Passport No.:
Winz No.:

Please insert WINZ No. if applicable
Attach Copy of your ID
Accepted file types: jpg, gif, png, pdf, tif, Max. file size: 100 MB.
Names and ages of all other occupants:*
Are you or any other occupant a smoker?*
- Yes
- No

Emergency Contact Person's Name*
First Last
Relationship*
Emergency Contact's Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Emergency Contact's Mobile*
Emergency Contact's Email*

Employment Situation for Reference Check: Company Name*

Please provide employers name and contact details if you are currently employed.
Weekly Income (before tax)*
Contact Name of Employer*
May we contact this person for a reference?*
- Yes
- No
Employer's Phone number
Employer's Email

1. Referee Name*

Please provide two referees that we can contact. Referees can be a friend, co-worker, your employer or someone who knows you well. One of your referees should be able to provide a reference about your credit worthiness. If you have already provided your current landlord details, only one additional referee is needed. Please let these people know we may be contacting them for a reference.
Relationship*
Phone number for first referee*
Email for first referee*
2. Referee Name:*
Relationship*
Phone number for second referee*
Email for second referee*

I authorise the Landlord/Property Manager to:*
- collect, retain, use and share this information for the purposes of completing background checks, reference checks and/or for assessing my creditworthiness; and
- carry out a fines check including providing my identification information to the MOJ and for the MOJ fine response to be disclosed to credit reporting agencies and the Landlord/Property Manager
- disclose information about me, whether collected from me directly or from any other source, to any other credit provider or any credit reporting agency for the purposes of providing or obtaining a credit reference.
Confirmation (Please tick to confirm)*
- I confirm I am over 18 and to the best of my knowledge, the information I have supplied is true and correct.
Signature*

By typing your name in the space provided you are electronically signing the tenancy application form.
Date:*

Under the Privacy Act 1993, you have the right to ask for a copy of all information held about you, and have the right to request the correction of any incorrect information.
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