PERSONAL DETAILS CONTINUED

The following questions must be answered:

1. Has your tenancy ever been terminated by a landlord or agent? Yes/No

If yes, please give details………………………………………………

2. Have you ever been refused a property by any Landlord or agent? Yes/No

If yes, please give details………………………………………………

3. Are you in debt to another landlord or Agent? Yes/No

If yes, please give details………………………………………………

4. Have any deductions ever been made from your rental bond? Yes/No

If yes, please give details………………………………………………

5. Is there any reason known to you that would effect your future rental payments? Yes/No

If yes, please give details………………………………………………

6. I acknowledge that the landlord and landlord’s agent will rely on the truth of the above

answers in assessing the application for the tenancy.

OFFICE USE ONLY

RENT $..........................................Employment details confirmed Yes/No

BOND $..........................................Previous agents or landlord contacted Yes/No

OTHER $...........................................100 points checklist passed Yes/No

LESS DEPOSIT $...........................................TICA check completed by phone Yes/No

OWING $...........................................Landlord contacted Yes/No

GENERAL COMMENTS:

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………...............

Tenant signature 1………………………………2………………………………3………………………….