Rental Application Form - First Page

PERSONAL INFORMATION

Full Name: ____________________________

Social Security Number: _________________

Drivers License Number: _________________ Expiry Date: _______________________

Mobile Number: ________________________

Home Number: ________________________

Email Address: ________________________

Current Address: ___________________________________________________________

Duration of Stay at Current Address: _______

Current Landlord's Name: ________________

Current Landlord's Number : ______________

Current Landlord's Address: __________________________________________________

RELATION INFORMATION

Martial Status: [ ] Single [ ] Married [ ] Living with a Partner

Details of Occupants Living Together:

Relationship Age Gender

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-
-
-
-

Next of Kin's Name: _____________________

Next of Kin's Number : ___________________

Next of Kin's Address: ______________________________________________________

No. of Smokers (if any): __________________

Pets Reared (if any): ____________________

Renters Application - Second Page

INCOME INFORMATION

Employment Status: [ ] Employed [ ] Self Employed [ ] Unemployed

Job Occupation and Title: ________________

Average Monthly Income: ________________

Duration of Employment: _________________

Company Name: ________________________

Company Number : ______________________

Company Address: _________________________________________________________

OTHER INFORMATION

[ ] Are you going to claim any housing benefits or subsidies?

If yes, please provide details: ____________________________________________

[ ] Have you ever been evicted from a tenancy for any reason?
If yes, please provide details: ____________________________________________

[ ] Have you ever intentionally refused to pay rent that is due?

If yes, please provide details: ____________________________________________

[ ] Have you ever filed for bankruptcy or is currently bankrupt?

If yes, please provide details: ____________________________________________

[ ] Are there any court judgments against you for any reason?
If yes, please provide details: ____________________________________________

PERSONAL DECLARATION

I declare that the information that I have provided here are true and updated to the best of my knowledge.

I hereby authorise the prospective landlord (Landlord's Name: ______________________ )

to carry out any background and credit checks necessary to verify my particulars and standing.
I also authorise the prospective landlord to contact my current landlord, employer, next of kin and other
related person for references.

Important Note: Providing false information to a landlord in order to obtain a tenancy are legal grounds
for terminating that tenancy with immediate effect.

_________________________
Applicant’s Signature

Applicant's Name: ______________________

Date (dd/mm/yyyy): _____________________