Rental Application Form - Harcourts (Page 3 of 3) in pdf

D. EMPLOYMENT HISTORY

What is your occupation?__________________________________________________________________________

Company name:_________________________________

Company Address:_______________________________

Contact name:___________________________________

Contact phone number:__________________________

Length of employment:___________________________

Gross annual income: $___________________________

E. W.I.N.Z

 Yes

 No

Do you receive a benefit?

What is your WINZ number? ______________________

Will your rent be paid direct from WINZ?  Yes

 No

If yes, please attach a copy of application form for rent to be paid direct from

WINZ – this needs to be signed by the landlord/agent

F. NEXT OF KIN CONTACT DETAILS

(please provide a contact not living with you 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: ____________________________________

Council Registration Number: ______________________

Type/Breed: ____________________________________

Council Registration Number: ______________________

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.

TENANCY INFORMATION NEW ZEALAND 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.

If I am declined this tenancy for reasons of a bad credit history or Tenancy Tribunal orders against me, I am aware that this may be placed on a tenancy database

Applicants Name and Signature: ________________________________________________________________________________________________________

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:

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

My referees

My employer

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.

Applicants Signature:_________________________________________

Date:______________________________