PERSONAL DETAILS
Full Name: _______________________________________________________________________________________
Title: Mr / Mrs / Ms / Other ___________________ Date of Birth: _____________________________________
Current Address: _____________________________________________________________ Postcode:___________
Home Phone: _____________________ Work Phone: _____________________ Mobile: __________________________
Fax: _________________________ E-mail: ______________________________________________________________
Driving Licence Number: ________________ Medicare Number: __________________ Occupation: __________________
Vehicle Registration Number: _______________ State of Registration: __________________
Make & Model of Car/ Motorbike: _______________________________________
IDENTIFICATION
By signing this application, the Applicant hereby authorises the Agent to make and retain copies of the following documents:
Documents:
Last FOUR Rent Receipts or Rates Notice if you own you own property
Driving Licence or Birth Certificate or Passport
Medicare Card
2 recent payslips or evidence of regular payments from Centrelink
2 recent Phone or 2 recent Gas or 2 recent Electricity Bills
Current car/motorbike registration papers
Additional if available: 2 references from previous landlords/agents
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GENERAL DETAILS
Number of occupants: Adults: _____________ Children_____________ Pets: _______________
Full names and ages of children:_________________________________________________________________
Type/breed and age of pets: _____________________________________________________________________
Pet Registration Details: ____________________________________________
Do you own a lawnmower: yes / no Do you smoke: yes / no
Would you be prepared to pay rent by direct debit: yes / no
FINANCIAL INSTITUTION DETAILS
Bank/Building Society: _________________ Branch: ___________ BSB: __________ Account No: _______________
EMPLOYMENT DETAILS
Employer’s Name: ____________________________ Work Phone: ____________ Mobile: _________________
Employer’s Address: ___________________________________________________ Post Code: _____________
Employment Commenced: ___________________ Nett Weekly Income (excluding Overtime): $_____________
If employed at the above for less than 12 months, please provide PREVIOUS employment details:
Employer’s Name: ____________________________ Work Phone: _____________ Mobile: ________________
Employer’s Address: ___________________________________________________ Post Code: _____________
Period of Employment: ___ / ___ / ___ to ___ / ___ / ___ Nett Weekly Income (excluding Overtime): $__________
SELF-EMPLOYED / OWN BUSINESS(only complete if this applies to you)
Name of Business: ______________________________________________ ABN: ________________________
Business Address: _________________________________________ Personal Nett Income/Week: $_________
What your Business does: _____________________________________ How long in this business: __________
If self-employed/own business for less than 12 months, please complete Previous Employment Details in the section above
STUDENT(only complete if this applies to you)
Name of Institution: _________________________________ Student Identification Number: _______________
Faculty/Department/Subject: _________________________________ Course Start date: __________________
Income Source: __________________________________________ Nett Weekly Income: _________________
CENTRELINK PAYMENT(only complete if this applies to you)
Type of payment: ____________________________________ Customer Reference Number: _______________
PERSONAL REFERENCES
Note: Only 1 personal reference may be a relative. All must have known you for 1 or more years and must be Permanent Residents of Australia.
1. Name: ________________________________ Address: __________________________________________
Relationship to you: _______________________ Known you for how long?:_____________________________
Home Phone: ______________________ Work Phone: ____________________ Mobile:___________________
2. Name: ________________________________ Address: __________________________________________
Relationship to you: _______________________ Known you for how long?:_____________________________
Home Phone: ______________________ Work Phone: ____________________ Mobile:___________________
3. Name: _________________________________ Address: _________________________________________
Relationship to you: _______________________ Known you for how long?:_____________________________
Home Phone: ______________________ Work Phone: ____________________ Mobile:___________________
4. Name: _________________________________ Address: _________________________________________
Relationship to you: _______________________ Known you for how long?:_____________________________
Home Phone: ______________________ Work Phone: ____________________ Mobile:___________________
TENANCY DETAILS
Current Landlord/Agent: _____________________________________ Phone: ___________________________
Address of Rental: _________________________________________ Date Lease commenced: _____________
Rent per week: $________ Reason for Leaving: ____________________________________________________
Any reason why Bond may not be refunded?_______________________________________________________
Previous Landlord/Agent: ____________________________________ Phone: ___________________________
Address of Rental: __________________________________ Date Lease began: _________ Ended: _________
Rent per week: $_______ Reason for Leaving: _____________________________________________________
Bond refunded? Yes / no If no, reason: ___________________________________________________________
Have you ever been evicted by any Landlord/Agent? yes / no
If YES, give details: ___________________________________________________________________________
Have you ever been refused another property by any Landlord/Agent? yes / no
If YES, give details: ___________________________________________________________________________
Are you in debt to another Landlord/Agent? yes / no
If YES, give details: ___________________________________________________________________________
Please state any reason known to you that would affect your Rental payments:
__________________________________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________
PRIVACY POLICY
The Agent: COVERDISK PTY LTD trading as WHALE COAST REALTY
3 Field Street Narooma NSW 2546
(02) 4476 2699
Full Name of The Applicant: _______________________________________________
The personal information the prospective tenant provides in this application or collected from other sources is necessary for the Agent to verify the Applicant’s identity, to process and evaluate the application and to manage the tenancy.
Personal information collected about the Applicant in the application and during the course of the tenancy (if application is successful) may be disclosed for the purpose for which it was collected to other parties including the landlord, referees, other agents and third party operators of tenancy reference databases.
If the Applicant enters into a Residential Tenancy Agreement and if the Applicant fails to comply with their obligations under that Agreement, that fact and other relevant personal information collected about the Applicant during the course of the tenancy may also be disclosed to other parties, including those referred to above.
Information already held on tenancy reference databases may also be disclosed to the Agent and/or landlord.
If the Applicant would like to access the personal information the Agent holds, they can do so by contacting the Agent at the address and contact numbers contained in this application. The Applicant can also correct this information if it is inaccurate, incomplete or out-of-date.
If the information is not provided, the Agent may not be able to process the application and manage the tenancy.
Should this application not be accepted, the Agent is not required or obligated to disclose why or supply any reason for the rejection of this application unless the application is declined as a result of the Applicant’s name being listed with a tenancy database.
I, the said applicant, do solemnly and sincerely declare that all the information contained in this application is true and correct and that all of the information was give of my own free will. I further confirm and declare that I have read and understood the 4 pages of this Application.
Applicant’s Signature: ___________________________________________ Date: __________________
Agent’s Signature: ______________________________________________ Date: __________________