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Application for Residential Tenancy

Applicant Details
Title :
Surname :
Firstname :
Middle Name :
Date of Birth :
Phone Number :
Mobile Number :
Best Time to Contact :
Email :
Proof of ID to form to be provided :
Passport :
Driver license No :
Student ID :
Other :
Source of Income
WINZ Number :
Total Weekly Income :
Employer :
Occupation :
Contach Ph Number :
Length of Current Employment :
Motor Vehicle Details
Make / Model / Year:
Car Registration No :
Smoking :
No Of Children :
Ages :
Details of Pets (Cat) and Age :
Details of Pets (Dog) and Age :

Partner / Spouse
Title :
Firstname :
Middlename :
Lastname :
Date of Birth :
Contact ph Number (day) :
Mobile :
Email :
Proof of ID to form to be provided :
Passport :
Driver license No :
Student ID :
Other :
Source of Income
WINZ Number :
Total Weekly Income :
Employer :
Occupation :
Contach Ph Number :
Length of Current Employment :
Motor Vehicle Details
Make / Model / Year:
Car Registration No :
Smoking :

Current Tenancy Details :
Current Address :
Length of time at this address :
Rent Paid :
Reason for leaving :
Current Landlords Name :
Current Landlords Contact No. :

Previous Tenancy Details :
Previous Address :
Length of time at this address :
Rent Paid :
Reason for leaving :
Previous Landlords Name :
Previous Landlords Contact No. :

Other intended occupants	(If application is successful a separate form will be required)
Fullname :
Relationship :
Age :
Fullname :
Relationship :
Age :
Fullname :
Relationship :
Age :

Address for Service (Emergency Contact)
Name :
Phone :
Address :

Confirm Application
I Acknowledge and Agree with the term and conditions provided in the Privacy Act