Applicant Details Sheet (25.03.13)

BLACK = Old Item/Clause | RED = New Item/Clause | BLUE = Comments About Change (Not Part of Form) | STRIKEOUT = Wording Deleted

Item 1.1

Current Address: …………………………………………………………………………………………………...

Period of Occupancy: ……………… Situation: Renting/ Owned/ Other Other Situation: ……………….

Landlord/Agent Details (if applicable): Name: ……………………………………Phone: ……………………..

Email: …………………………………………………………………………………Phone: ……………………..

Rent: ……………… per Week/ Fortnight/ Month Reason for Leaving: ……………………………..……….

Item 1.2

Previous Address (if applicable): ………………………………………………………..………………….…..

Period of Occupancy: ……………… Situation: Renting/ Owned/ Other Other Situation: ………………..

Landlord/Agent Details (if applicable): Name: ………………………………………Phone: …………………...

Email: ………………………………………………………………………...…………Phone: …………………...

Rent: ……………… per Week/ Fortnight/ Month Reason for Leaving: ……………...……………………….

Item 4

Next of kin Name:……………..…....……………….………………………………Phone: ……………………..

Address: …………………………………..………………………………………..Mobile: …………………….

Other: ……………………………………………………………..………………..… Phone: …………………….

Address: ………………………………………………..………………………..…… Mobile: …………………….

Applicant Details Sheet

__ I, the Applicant, give my consents for to the Agent to make making enquiries (in accordance with the Privacy Statement on the Application for Tenancy Form) to verify the information I have provided herein.

__ I, the Applicant, have has read and agree to the information provided in the Application for Tenancy Form & agrees to be bound by the Terms of Application detailed in the Application for Tenancy Form attached thereto.

The Applicant consents to the Agent making enquiries (in accordance with the Privacy Statement on the Application for Tenancy Form) to verify the information provided herein.

__ Yes __ No

The Applicant has read the Application for Tenancy & agrees to be bound by the Terms of Application attached thereto.

__ Yes __ No

Prior to signing this Application ,the Applicant has been given a Form 18a General Tenancy Agreement (including Standard and any Special Terms) in accordance with Section 58 of the Residential Tenancies and Rooming Accommodation Act 2008.

__ Yes __ No

Applicant’s Signature: Landlord’s/ Agent’s Signature:

……………………………………. ……/……/…… ………………………………….. ……/……/……