94 High Street, Maryborough , 3465 VIC
P: 03 5460 5100 F: 03 5461 4738
RESIDENTIAL TENANCY APPLICATION FORM
Date 25 May 2013
Rental Property Details
Address:
Postcode:
Rental Amount: $ Weekly
Bond: $
Tenancy Start Date:  date picker
Term: Months
(Preference given to tenants seeking 12 month lease)
How many people will reside at the property?
Adults:
Children:
Ages:
Pets? Yes No
If so how many?
What type?
Application Details
Title:
Surname:
Given Name/s:
Partnets Name:
Date of Birth:
Home Ph:
Work Ph:
Mobile:
Email Address:
Driver’s Licence No:
Identification Checked:
Current Address:
Postcode
How long at this address: Years Months
If Rented, Current rental amount: $ Per Week
Current landlord/agent:
Phone no. of landlord/agent:
Reason for leaving:
Emergency Contact / Next of Kin (Not living with you):
Name:
Relationship with the applicant:
Address:
Home Ph:
Work Ph:
Mobile:
If you receive a Centrelink Payment
(Copy of most recent payment statement to be supplied)
Type of payment:
Customer Reference Number (CRN):
1. Are you able to pay rent by Direct Debit? Yes No
(Rent is only taken by direct debit——no cash)
2. Will you be seeking Government Rent Assistance? Yes No
3. Will you be seeking a bond from Government/Comm. Service? Yes No
Employment Details
Currently employer:
Occupation:
Type of employment:
Length of Employment: Years Months
Net income per week: $
Address:
Postcode:
Contact Person:
Phone:
References
(People with Position of Standing Preferably in the Ballarat Com-munity. No Relatives, Personal Friends, Agents)
1. Name:
Relationship with the applicant:
Home Ph:
Mobile:
Occupation:
Work Ph:
2. Name:
Relationship with the applicant:
Home Ph:
Mobile:
Occupation:
Work Ph:
3. Name:
Relationship with the applicant:
Home Ph:
Mobile:
Occupation:
Work Ph:
Utility Connections
If you would like assistance, (at no additional charge) with connection and disconnection of telephone, electricity, gas and water to your new homehome then tick the boxes below. “On the move will contact you and explain the Details of the service available
YES! I would like On the Move to contact me to arrange my utility connections
YES! I would also like to discuss disconnection at my old address
No
If you are a student
Name of Institution:
Faculty / Department:
Income Source:
Net weekly income: $
Student Identification (ID) Number:
a) Have you ever been refused a property by an Agent or Landlord? Yes No
If yes, provide details why
b) Have you ever been evicted by any Landlord or Agent? Yes No
If yes, provide details why
c) Are you in debt to any Landlord or Agent? Yes No
If yes, provide details why
d) Is there anything that could affect you making rental payments? Yes No
If yes, provide details why
e) Were there any deductions from your rental bond at your last address? Yes No
If yes, provide details why
Declaration
In accordance with Privacy Principle 1.3 of the Privacy Act I/We acknowledge the Agent’s requirement the I/We read and sign this acknowledgement. In order to process a tenancy application I am/ we are required under the National Privacy Principles of Privacy Act to be made aware that the Agent may access a database. In addition I/we acknowledge that I/we are entitled to know what will happen to this information when it is passed on to an agent.
We, as the agent disclose that during the term of your tenancy, your personal information may be disclosed to the Landlord, Landlord’s lawyers, Landlords mortgagee, referees you have nominated, organizations/ tradespeople required to carry out maintenance to the premises, Rental Bond Authorities, Residential Tenancy Tribunals/Courts, Collection Agents, Insurance Companies, Government Departments, tenancy database companies and other Real Estate Agents and Landlords. At some stage information may also be disclosed to an overseas landlord who may not be an Australian Citizen. We also collect your personal information to
  • Enable us to prepare the lease/tenancy documents for the premises.
  • Allow organisations / tradespeople to contact you in relation to maintenance matters relating to the premises.
  • Pay/release rental bonds to/from Residential Tenancies Bond Authority (where applicable).
  • Refer to tribunals, Courts and Statutory Authorities (where necessary).
  • Refer to Collection Agents/Lawyers (where default/ enforcement action is required).
  • Provide confirmation details for organisations contacting us on their behalf, i.e banks, utilities (gas, electricity, water and phone), employers, etc.
In acknowledging the above, I/we give my/our permission to the Agent to provide my/ our information to future Landlords or agents about information records or other assessments of the tenancy upon which I/we may be approved pursuant to this application.
I/we the said Applicants/s declare/s that I/we give my/our permission to the Agent to collect my/our information and pass such information on to a National Tenancy Data-base, contact number available by contacting Ballarat Real Estate Pty Ltd on 5331 2233.
I/we understand that by signing this application consent is given to the Agent to contact any of my/our referees, employees, previous Agents or Lessors provided by me/us in the tenancy application to provide information to the Agent.
I/we agree that in the event of a default occurring under the tenancy agreement, I/we give my/our permission to the member of the tenancy database to register any of my/our details of such breach with a tenancy database. I/we further agree and understand that the removal of such information from a database company is subject to the condi-tions of the database company.
I/we understand that the database company allows its members to access information accumulated from members about tenants who have breached their tenancy agreement.
I/we agree and understand that should I/we fail to provide the agent with the information reasonably requested in this application that the Agent may not elect to proceed with my/our tenancy application.
I/we agree and understand that a listing with the above tenancy database company could have an adverse effect on my/ our ability to obtain future rental accommodation.
I/we acknowledge and understand that the database company listed above can be contacted by obtaining the phone number from Ballarat Real Estate Pty Ltd.
I/We acknowledge that the Agent may use my/our personal information for marketing purposes by the Agent to me/us.
Applicant’s Signature
It is also agreed that upon communication of acceptance of this application by the Agent that payment of the first month’s rent is required forthwith.
The information collected is held in files at our office and can be accessed by you at anytime, by applying to Ron Morrison on 5331 2233.
By submitting this form:
  • I acknowledge that I have inspected the property for which this application applies and that I am satisfied with its condition and cleanliness.
  • I agree that I have read and understand this application and that I have read and accept all the conditions contained within it;
  • I consent to the disclosure set out in the authority to release tenant information;
  • I have read the Privacy Information Agreement and confirm that all details provided in this application are correct; and
  • I authorise Ballarat Real Estate Pty Ltd to make enquires it considers necessary to verify the information contained in this application.
  • I/we make this application subject to the availability of the said premised on the due date and agree that I will take no action against the Landlord/Agents should the premises not be ready for occupation by the due date.
  • I/we also do solemnly and sincerely declare that the above information is true and correct and has been supplied on my/our freewill to assist the Agent in assessing this application.
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