t e n a n c y a p p l i c a t i o n f o r m

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fitzpatricks real estate

Rent

Pets

Internet /telephone

Photo Identification eg; Drivers Licence OR Proof of Age Card OR Current Passport (COMPULSORY)

Proof of Income 1 (COMPULSORY)

Proof of Income 2 (COMPULSORY)

Current Bank Statement - bank statement from internet without name and address will not be accepted.

Recent Payslip or Centrelink Statement

30

15

15

Rental Ledger OR last 4 Rent Receipts OR front page of current Lease Agreement

Electricity / Gas OR Phone Invoice with current address

Motor Vehicle OR Motor Bike registration

Copy of Birth Certificate

Debit / Credit Card

Water OR Council Rates with current address

NUMBER OF POINTS

20

10

10

10

10

10

Medicare Card / Health Care Card 10

/100

’

Other Applicants:A separate application form must be completed for each applicant intending to be named on the lease

Names of additional applicants:

138 Baylis Street, Wagga Wagga NSW 2650 Ph: +61 2 6939 7177Fax: +61 2 6931 0200

Email: rentals@fitzpatricks.com.au Website: www.fitzpatricks.com.au

If you receive any form of Government Assistance, written confirmation MUST be included. If you are self-employed, a copy of your Profit & Loss statement and Accountant details will be required for proof of income.

Submitting an application without the relevant documents will delay or prevent your application from being processed.

In the event a Direct Debit dishonours, the tenant shall compensate the Agentimmediately for costs incurred.

The tenant agrees not to keep any pets at the property under any circumstances without prior written consent from the owner.

F. S

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Signature Date

For your application to be processed you must answer all questions

X / /

Our office only accepts payment of rent by Direct Debit from your bankaccount.If your application is approved, bank details will need to be provided at your lease signing appointment.Please sign to acknowledge you have read Section D and understand and agree to pay rent by Direct Debit.

D.

TERMS OF TENANCYWhat lease term will you commit to?

6 months OR 12 months Other: ____________

Date you would like to commence the lease?

Day Month Year

Property rent?

PER Week $

Home phone no. Mobile phone no.

Work phone no. Other no.

Email Address

Postcode

Mr Ms Miss Mrs Other

Surname Given name/s

Language spoken at home

Driver’s licence no. (Photocopy required)

Date of Birth

Passport no. Passport country

Pension / Centrelink no.(if applicable) Pension type (if applicable)

Car Registration no.

Adults Children (Ages: _______________________ )

A.

PROPERTY DETAILSB.

C.

Postcode

E. DISCLAIMER / AUTHORITYI hereby offer to rent the property from the owner under a lease to be prepared by the Agent. Should this application be accepted by the landlord I agree to enter into a Residential Tenancy Agreement.

I acknowledge that this application is subject to the approval of the owner/landlord. I declare that all information contained in this application (including the reverse side) is true and correct and given of my own free will. I declare that I have inspected the premises and am not bankrupt. I, the tenant, accept the property in the condition it was in when inspected.

I authorise the Agent to obtain personal information about me from:(a) The owner or the Agent of my current or previous residences;(b) My personal referees and employer/s;(c) Any record listing or database of defaults by tenants such as TICA, NTD or TRA for the purpose of checking my tenancy history. I am aware that I may access my personal information by contacting:TICA 1902 220 346 or website www.tica.com.auNTD 1300 563 826 or website ntd.net.auTRA (02) 9363 9244 or website www.tradingreference.com

I am aware that the Agent will use and disclose my personal information within this application in order to:(a) communicate with the owner and select a tenant(b) prepare lease/tenancy documents(c) allow trades-people or equivalent organisations to contact me(d) lodge/claim/transfer to/from a Bond Authority(e) refer to Tribunals/Courts & Statutory Authorities (where applicable)(f) refer to collection agents/lawyers (where applicable)(g) complete a check with TICA

I am aware that if information is not provided or I do not consent to the uses to which personal information is put, the Agent cannot provide me with the lease/tenancy of the premises. I am aware that I may access personal information on the contact details above. I alsohave the right to correct this information if inaccurate, out of date or incomplete with the relevant parties.To view Fitzpatricks Privacy Statement go to www.fitzpatricks.com.au/privacy

Signature Date

/ /X

Email address used for all notifications

OR Tick here to opt out

Yes, Please Contact Me

Unless I have opted out of this section, I/we:Consent to the disclosure of information on this form to myconnect ABN 65 627 003 605 for the purpose of arranging the connection of nominated utility services; consent to myconnect disclosing personal information to utility service providers for the stated purpose and obtaining confirmation of connection; consent to myconnect disclosing confirmation details (including NMI, MIRN, utility provider) to the Real Estate Agent, its employees and myconnect may receive a fee/incentive from a utility provider in relation to the connection of utility services; acknowledge that whilst myconnect is a free service, a standard connection fee and/or deposit may be required by various utility providers; acknowledge that, to the extent permitted by law, the Real Estate Agent, its employees and myconnect shall not be liable for any loss or damage (including consequential loss and loss of profits) to me/us or any other person or any property as a result of the provision of services or any act or omission by the utility provider or for any loss caused by or in connection with any delay in connection or provision of, or failure to connect or provide the nominated utilities. I acknowledge that myconnect record all calls for coaching, quality and compliance purposes.

1300 854 478 enquiry@myconnect.com.au myconnect.com.au

MyConnect will call you to arrange freeconnection of your required utilities

Macintosh HD:Users:bettinaruhl:Downloads:Tenancy application form.doc

G. APPLICANT HISTORY REFERENCES6. How long have you lived at your current address?

Years Months

7. Are you renting or a home owner? Renting Home Owner

8. Why are you leaving your current address?

9. Current Agent/Landlord details Name of landlord or agent

Landlord/agent’s phone no. Weekly rent paid

10. What was your previous residential address?

11. How long did you live at this address?

Years Months

12. Agent/Landlord details of this property (if applicable) Name of landlord or agent

Was bond refunded in full? If not why not?

H. EMPLOYMENT HISTORY13. Please provide your employment details

What is your occupation?

Employer’s name (inc. accountant if self employed or institution if a student)

Employer’s address

Contact name Phone no.

Length of employment Net income PW / PF?

Years Months

14. Please provide your previous employment details Occupation

Employer’s name Phone no.

Length of employment

Years Months

I. EMERGENCY CONTACT (not living in the same property)

15. Please provide a contact in case of emergencySurname Given name/s

Address Phone no.

16. Please provide two personal references (not related to you)

1. Surname Given name/s

Relationship to you Phone no.

2. Surname Given name/s

Relationship to you Phone no.

K.

EXTRA INFORMATION

OTHER INFORMATION

J.

18. Are you intending to keep pets at this property? If yes, please provide details of any pets Breed / Type Pets inside/outside Age of Pet

19.

20. I Confirm the following:

2

22.

23.

24.

Items you believe need attending prior to occupation (subject to owner’s approval):

1. Do you have a bond account with the Rental Bond Board?

Important information

Please answer the following questions: Yes No

$

Postcode

Postcode

$

Net income PW / PF?

$

1.

2.

I declare that I have inspected the premises and understand the landlord is not obliged to make improvements.

YES NO

no.

Landlord/agent’s phone no. Weekly rent paid

$ no.

YES NO

YES NO

The Holding deposit and Rental Bond amount are to be paid in advance, prior to lease signing.

Cash is not accepted at our office.Bank cheques, money orders and EFT transfer will be accepted for these payments.

Have you ever been evicted by any landlord or agent?

Are you in debt to another landlord or agent?

Is there any reason that would affect your rent payment?

I agree that smoking is strictly prohibited inside the property at all times

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