Cnr Apsley Drive & Withells Road,
Christchurch New Zealand 8042
PH : (03) 358 7469
Fax : (03) 358 9149

73 Peterborough Street,
Christchurch New Zealand 8013
Postal : PO Box 80036

A. PROPERTY APPLIED

Property Address applying for

Date Required

B. PERSONAL DETAILS

Please give us your details

Title

First Name

Middle name

Last Name

Home phone no.

Mobile phone no.

Number of Children

Age of Children

Details of Pets

Smoking

Drivers licence No.

Drivers licence version number (3-digit number)

Car Registration No.

Passport no.

Passport Country

Date of Birth

Email Address

C. PARTNER/SPOUSE

Title

Full Name

Mobile phone no.

Email Address

Date of Birth

Drivers licence No.

Drivers licence version number (3-digit number)

Car Registration No.

Passport no.

Passport Country

D. NEXT OF KIN AND EMERGENCY CONTACT

Name

Relationship

Address

Home phone no.

Mobile phone no.

E. Occupation

Occupation

Employer

Employer Address

Student

Institution

Course

Period of employment Years……. Months…….

Business Phone

F. PARTNER/SPOUSE OCCUPATION

Occupation

Employer

Employer Address

Student

Institution

Course

Period of employment Years……. Months…….

Business Phone

G. PRESENT ADDRESS

Present Adress

Period of Occupancy

Rent Paid

Name of Agent or Owner

Business Phone

Reason for leaving

H. PREVIOUS ADDRESS

Previous address how long Years…..Months…….

Period of Occupancy

Rent Paid

Name of Agent or Owner

Owners Day Phone

Reason for leaving

I. NAME OF ALL PERSONS WISHING TO RESIDE AT ADDRESS

Name

J. ADDITIONAL SUPPORTING REFERENCE

Name

Phone

Name

Phone

K. DECLARATION

(1) Tenants understand no illegal drugs are allowed on the premises? The tenancy agreement allows us authority to carry out Meth & P-Lab testing .

(2) Have you ever been evicted or taken to Tenancy Tribunal by an owner or agency?

(3) Were any deductions made from your bond at your last tenancy?

(4) All information provided by me on this application is true and accurate, and that I have read and understood the Privacy Act Statement below.

(5) Upon acceptance of this application, I confirm that we have checked out the location and presentation of their property.

(6) I authorise any person or company to provide you with information that may be required to determine my suitability as tenant.

(7) I consent to you providing any information on this form and any details of any proven breach of my tenancy or of the Residential Tenancies Act 1986 to any credit bureau, tenant default database or prospective owner'(s).

(8) I agree to pay and clear all initial monies up front. I understand that my tenancy can be canceled if the full monies are not paid and cleared by the tenancy start date. I understand that all deposits are non-refundable.

(9) Once your application has been accepted and deposit paid then you are deemed to have agreed to the start date, term of tenancy and fees for property.

L. Privacy Act 1993 Statement:

This application collects personal information that is held and used by Initial Realty Ltd. The information is collected to assess your suitability as a tenant and provided to credit bureaus' or tenant default companies should a tenancy breach occur. Your information will be publicly accessible where you have the right to access and correct any details in accordance with the Privacy Act. I authorise the release of any information held on any credit bureau or tenant default company. NB: If you fail to provide the necessary information that we may require, then your application may be declined.

RESIDENTIAL TENANCY APPLICATION