PROPERTY DETAILS YOU WANT TO RENT
( Please complete all fields or write N/A if not relevant )
Property Street address
Suburb/Town
Postcode
Property rental amount	Weekly Monthly
Bond

Lease Commencement Date?		Click to enter date
Lease terms (months)

Number of adults
Number of children		Ages

PERSONAL DETAILS

Title	Choose Mr Ms Miss Mrs Other
First name
Last name
Date of birth	31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 09 08 07 06 05 04 03 02 01 Day Month Jan Feb March April May June July Aug Sept Oct Nov Dec Year 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900
Contact number - BH
Contact number - AH
Mobile number
Facsimile
Email

Pets

Yes

No

If yes, what breed or type?
Council Registration number?

IDENTIFICATION

Current drivers licence or passport number
State of licence or country of passport
Pension Type and Number
Car Make and Model
Car Registration No

APPLICANT RENTAL HISTORY

Current address
How long at this address?	Years Months
Why are you leaving this address?

Landlord/Agent details
Contact number - BH
Weekly Rent

PREVIOUS LANDLORD/AGENT

Previous address
How long at this address?	Years Months
Landlord/Agent
Contact number - BH
Weekly Rent
Was bond refunded in full? If not why not?

EMPLOYMENT HISTORY

Occupation
Full time Part time or Casual	Full Part Casual
Current employer's Name	(accountant if self-employed or institution if a student)
Employer's address
Suburb/Town
Postcode
Contact name
Contact number
Length of employment	years Months
Net Income

PREVIOUS OCCUPATION

Occupation
Previous employer
Contact number

Employment period Months

Net Income

CONTACT REFERENCES

Reference 1
Full Name
Relationship to you
Contact number

Reference 2
Full Name
Relationship to you
Contact number

EMERGENCY INFORMATION

Full Name Next of Kin
Relationship
Contact number

I accept that Frank Trimboli Real Estate may conduct independent reference and credit checks on this application.

UTILITY CONNECTIONS

Utility connection services are provided by:
A FREE utility connection service.

If you would like MyConnect to contact you to discuss the connection of electricity, gas and telephone, internet, water or pay TV (if applicable) to your new home then tick the box below. MyConnect will then contact you and explain the details of the services available.

While the MyConnect service is FREE, standard service provider connection fees and charges still apply. You pay NO extra charges as a result of using the MyConnect service.

Phone : 1300 854 478 Fax : 1300 854 479
enquiry@myconnect.com.au www.myconnect.com.au

Please contact me regarding CONNECTION of my utilities

A MyConnect representative will make all reasonable efforts to contact you within one working day of receiving an application. If MyConnect was unable to contact you within this period please contact MyConnect on 1300 854 478 to ensure connection is completed.

Utility connection services are provided by:

SEND APPLICATION

By clicking this SEND Button I confirm that I have read and agreed to the terms and conditions contained in the declaration below and certify that the above information supplied by me is true and correct.

DECLARATION

I hereby offer to rent the property from the owner under a lease to be prepared by the Agent. Should this application be accepted by the landlord I agree to enter in to a Residential Tenancy Agreement.

I acknowledge that this application is subject to the approval of the owner/landlord. I declare that all information contained in this application (including the reverse side) is true and correct and given of my own free will. I declare that I have inspected the premises and am not bankrupt. I, the tenant, accept the property in the condition it was in when inspected.

I authorise the Agent to obtain personal information about me from:

(a) The owner or the Agent of my current or previous residences;

(b) My personal referees and employer/s;

(c) Any record listing or database of defaults by tenants;

If I default under a rental agreement, I agree that the Agent may disclose details of any such default to a tenancy database, and to agents/landlords of properties I may apply for in the future.

I am aware that the Agent will use and disclose my personal information within this application in order to:

(a) communicate with the owner and select a tenant

(b) prepare lease/tenancy documents

(c) allow trades-people or equivalent organisations to contact me

(d) lodge/claim/transfer to/from a Bond Authority

(e) refer to Tribunals/Courts & Statutory Authorities (where applicable)

(f) refer to collection agents/lawyers (where applicable)

(g) complete a check with NTD (National Tenancies Database)

(h) transfer water account details into my name