Ver

12/10

Copy to Applicant Yes / No

Approved by
The Real Estate Institute
Of Western Australia (Inc.)
FOR USE BY MEMBERS

Receipt No................................

COPYRIGHT REIWA 2001

STANDARD APPLICATION AND OFFER OF OPTION

TO LEASE RESIDENTIAL PREMISES
This document is not a residential tenanc y agreement and does not grant an y right to occupy the Premises

INFORMATION FROM APPLICANT

Applicant: Mr/Mrs/Ms...........................................................................................................................................Telephone ................................................................
Applicant: Mr/Mrs/Ms...........................................................................................................................................Telephone ................................................................
Applicant: Mr/Mrs/Ms...........................................................................................................................................Telephone ................................................................
Surname

Given Names

TENANCY DETAILS
1.

Premises.....................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................

The tenancy is required for a period of .............................months

At a rental of $............................................................................................................................................................................................................................

Total number of persons to occupy Premises

5.

6.

From .............................................................. To .......................................................

Adults ...........................................................

Children ...........................................................

Ages .............................................................

Ages .................................................................

Pets - Type of Pet .........................

Breed.................................................................

Number ...................

Age .................................................

Type of Pet .........................

Breed.................................................................

Number ...................

Age .................................................

Do you intend applying for a Ministry of Housing Bond?

If yes,

$................................................................

Yes

No

Branch ................................. .................................................................................................

7.

Option Fee $................................................................

8.

If offer accepted, Period of Option: ...............................................................

business days from acceptance of Application ( see item 30)

AMOUNTS PAYABLE (if option exercised and lease entered into)

9.

Security deposit bond of

$..........................................

10.

Pet bond (if applicable)

$..........................................

11.

Initial rent to

..................../..................../....................

$..........................................

12.

Rent paid to

..................../..................../....................

$..........................................

13.

Letting Fee of

$..........................................

14.

Stamp Duty (plus duplicate) of

$..........................................

15.

Other

$..........................................

16.

Total due

$ ................................................

Option Fee (payable on application)

17.

( $............................................... )
$ ............................................

BALANCE OWING (cash or financial institution cheque only)

CONDITIONS RELEVANT TO MAKING AN APPLICATION AND OFFER

18.

The amounts referred to in Items 9 to 17 are payable upon the Applicant signing the Lease and/or prior to taking possession of the
Premises.

19.

The Applicant will not be entitled to occupation of the Premises until:

(i) vacant possession is provided by the current occupant of the Premises;
(ii) the Lease is signed by the Applicant; and
(iii) the payment of all monies due to be paid by the Applicant being paid by the Applicant prior to occupation of the Premises.

20.

The persons comprising the Applicant are over the age of 18 years, none are bankrupt and they each declare that all of the information
supplied in the applicants particulars are true and correct and are not misleading in any way.

21.

The Applicant acknowledges having inspected the Premises and if the Option is exercised, will accept possession of the Premis es in the
condition as at the date of inspection.

22.

Upon the e xercise of the option by the Applicant, the Applicant will execute the Lease. The Lease shall be the Standard
Residential Property Lease, including any special conditions included and/or attached to this Application and the payment of all monies
referred to in items 9 to 17.

23.

The Applicant agrees to pay the rent one period in advance except for the first two weeks rent, and to pay the letting fee to the maximum
amount allowable pursuant to Section 27 of the Residential Tenancies Act 1987.

24.

The Applicant acknowledges that they are responsible for their own contents. The Applicant should arrange their own insurance to cover
their own contents and determine if the insurer covers damage to Premises caused by a waterbed or the escape of water from a waterbed.

25.

The Applicant acknowledges and agrees that the Owner will carry out all inspections of the Premises between normal business hours.

26.

All acts and things which the Owner is required or empowered to do may be done by the Lessor or their appointed Managing Agent.
Notices to the Owner must be serv ed on the Managing Agent unless otherwise directed by the Owner.

27.

The Applicant makes this Application and Offer jointly and severally. Service of any notice to any one Applicant shall be deemed to be
service on them all.

28.

The Applicant agrees that for the purpose of this Application, the Owner/Managing Agent may make enquiries of the persons
given as referees by the Applicant, and also make enquiries of such other persons or agencies as the Owner may see fit.

29.

The Applicant acknowledges having been advised that items of personal information contained in this Application may be
recorded in a Tenancy Data Base by or on behalf of the Owner and may be disclosed in connection with other residential tenancy
applications by the Applicant.

OFFER OF OPTION TO OWNER

30.

The Applicant offers to the Owner an Option to lease the Premises. The Option to lease is created by the Owners notification to the
Applicant whether in writing or not that the Application and Offer is accepted by the Owner. The Option Fee payable with this
Application and Offer , shall be the amount referred to in item 7. The period of the Option shall commence from and include the date of
the acceptance of the Application by the Owner and continues for the number of business days referred to in item 8, or if none, then by
4pm two business days after the acceptance of the Application and Offer.

31.

The Option is exercised by the Applicant either:

(i) executing the Lease; or
(ii) taking possession of the Property with the Owners consent; or
(iii) giving a notice in writing to the Owner e xercising the Option;
whichever occurs first.

32.

If the Option is exercised by the Applicant, then the Option Fee paid is credited to the rental payable pursuant to the Lease. If not
exercised, then the Option Fee is the property of the Owner pursuant to section 27(2)(a) of the Residential Tenancies Act 1987.

33.

The Applicant encloses with this Application an Option Fee for the sum referred to in Item 7. It is agreed that the acceptance of this
Application is subject to the approval of the Owner at the Owners absolute discretion. The Applicant UNDERSTANDS THAT
WITHDRAWAL AFTER ACCEPTANCE OF THE APPLICATION AND OFFER WILL RESULT IN FORFEITURE OF THE OPTION
FEE.
[

] initials

34.

FIRST APPLICANTS PARTICULARS

Name

....................................................................................................................................................................................................................................
(SURNAME)

(GIVEN NAMES)

Present Address .......................................................................................................................................................................................................................

..................................................................................................................................................................................................................................................
Phone No Work ....................................................................................Phone No Home .......................................................................................................
Mobile

...............................................................................................Email ........................................................................................................................

Date of Birth ........................................................................................

Drivers Licence No ............................................................................. State .................................. Passport No .................................................................
Other ID ............................................................................................... Vehicle Type & Registration No .............................................................................
................................................................................................Vehicle Type & Registration No ..............................................................................
Proof of Identification (licence number/bankcard etc) ...........................................................................................................................................................
Smoker

Yes / No

Personal References
a) ..........................................................................................................................................................................
(name & telephone & relation to applicant)
b)...........................................................................................................................................................................
(i)

Name of current owner or managing agent to whom rent is paid ............................................................................................................................

Address .....................................................................................................................................................................................................................
Phone No ..................................................................................................................................................................................................................
Rental Paid $........................................................ Period rented From .................................... .................... To .....................................................
Reasons why leaving ................................................................................................................................................................................................
....................................................................................................................................................................................................................................

(ii)

Previous address of Applicant ..................................................................................................................................................................................

....................................................................................................................................................................................................................................
Name of previous owner or managing agent to whom rent w as paid ......................................................................................................................
Address .....................................................................................................................................................................................................................
....................................................................................................................................................................................................................................
Phone No ..................................................................................................................................................................................................................
Rental Paid $...................................................... Period rented From ...................................... .................... To ....................................................
Reasons why leaving ................................................................................................................................................................................................

(iii)

Occupation ................................................................................................................................................................................................................
Employer ............................................................................................. Period of employment ................................................................................
Phone No ................................................................................................................................................. Wage $....................................................
If less than 12 months, name and address of previous employer..............................................................................................................................
....................................................................................................................................................................................................................................

(iv)

Next of Kin (name and address and telephone and relation to applicant)
First person ................................................................................................................................................................................................................
Second person ............................................................................................................................................................................................................
Emergency Contact (name and address and telephone and relationship to applicant)
First person ................................................................................................................................................................................................................
Second person ...........................................................................................................................................................................................................

35.

SECOND APPLICANTS PARTICULARS

Name

....................................................................................................................................................................................................................................
(SURNAME)

(GIVEN NAMES)

Present Address .......................................................................................................................................................................................................................

..................................................................................................................................................................................................................................................
Phone No Work ....................................................................................Phone No Home .......................................................................................................
Mobile

...............................................................................................Email ........................................................................................................................

Date of Birth ........................................................................................

Drivers Licence No ............................................................................. State .................................. Passport No .................................................................
Other ID ............................................................................................... Vehicle Type & Registration No .............................................................................
................................................................................................Vehicle Type & Registration No ..............................................................................
Proof of Identification (licence number/bankcard etc) ...........................................................................................................................................................
Smoker

Yes / No

Personal References
a) ..........................................................................................................................................................................
(name & telephone & relation to applicant)
b)..........................................................................................................................................................................
(i)

Name of current owner or managing agent to whom rent is paid ............................................................................................................................

Address .....................................................................................................................................................................................................................
Phone No ..................................................................................................................................................................................................................
Rental Paid $........................................................ Period rented From .................................... .................... To .....................................................
Reasons why leaving ................................................................................................................................................................................................
....................................................................................................................................................................................................................................

(ii)

Previous address of Applicant ..................................................................................................................................................................................

....................................................................................................................................................................................................................................
Name of previous owner or managing agent to whom rent w as paid ......................................................................................................................
Address .....................................................................................................................................................................................................................
....................................................................................................................................................................................................................................
Phone No ..................................................................................................................................................................................................................
Rental Paid $...................................................... Period rented From ...................................... .................... To ....................................................
Reasons why leaving ................................................................................................................................................................................................

(iii)

Occupation ................................................................................................................................................................................................................
Employer ............................................................................................. Period of employment ................................................................................
Phone No ................................................................................................................................................. Wage $....................................................
If less than 12 months, name and address of previous employer..............................................................................................................................
....................................................................................................................................................................................................................................

(iv)

Next of Kin (name and address and telephone and relation to applicant)
First person ................................................................................................................................................................................................................
Second person ............................................................................................................................................................................................................
Emergency Contact (name and address and telephone and relation to applicant)
First person ................................................................................................................................................................................................................
Second person ...........................................................................................................................................................................................................
4

36.

THIRD APPLICANTS PARTICULARS

Name

....................................................................................................................................................................................................................................
(SURNAME)

(GIVEN NAMES)

Present Address .......................................................................................................................................................................................................................

..................................................................................................................................................................................................................................................
Phone No Work ....................................................................................Phone No Home .......................................................................................................
Mobile

...............................................................................................Email ........................................................................................................................

Date of Birth ........................................................................................

Drivers Licence No ............................................................................. State .................................. Passport No .................................................................
Other ID ............................................................................................... Vehicle Type & Registration No .............................................................................
................................................................................................Vehicle Type & Registration No ..............................................................................
Proof of Identification (licence number/bankcard etc) ...........................................................................................................................................................
Smoker

Yes / No

Personal References
a) .........................................................................................................................................................................
(name & telephone & relation to applicant)
b)..........................................................................................................................................................................
(i)

Name of current owner or managing agent to whom rent is paid ............................................................................................................................

Address .....................................................................................................................................................................................................................
Phone No ..................................................................................................................................................................................................................
Rental Paid $........................................................ Period rented From .................................... .................... To .....................................................
Reasons why leaving ................................................................................................................................................................................................
....................................................................................................................................................................................................................................

(ii)

Previous address of Applicant ..................................................................................................................................................................................

....................................................................................................................................................................................................................................
Name of previous owner or managing agent to whom rent w as paid ......................................................................................................................
Address .....................................................................................................................................................................................................................
....................................................................................................................................................................................................................................
Phone No ..................................................................................................................................................................................................................
Rental Paid $...................................................... Period rented From ...................................... .................... To ....................................................
Reasons why leaving ................................................................................................................................................................................................

(iii)

Occupation ................................................................................................................................................................................................................
Employer ............................................................................................. Period of employment ................................................................................
Phone No ................................................................................................................................................. Wage $....................................................
If less than 12 months, name and address of previous employer..............................................................................................................................
....................................................................................................................................................................................................................................

(iv)

Next of Kin (name and address and telephone and relation to applicant)
First person ................................................................................................................................................................................................................
Second person ............................................................................................................................................................................................................
Emergency Contact (name and address and telephone and relation to applicant)
First person ................................................................................................................................................................................................................
Second person ...........................................................................................................................................................................................................

37.

Special questions referring to all applications - Note it is an offence under the "Residential Tenancies Act" to provide false information.

Have any of the applicants previous tenancies been terminated? YES / NO .......................................................................................................................................
Are any of the applicants in debt to another lessor or agent? YES / NO ..............................................................................................................................................
Is there an existing reason of the applicants that may affect your rent payment? YES / NO .............................................................................................................
Have any of the applicants previous tenancies bond not payed out in full? YES / NO ......................................................................................................................
Are any of the applicants not residents / citizens of Australia? YES / NO ........................................................................................................................................

Are there any applicants receiving rent assistance from the government? YES / NO If so how much? .............................................................................................

Are any of the applicants going to conduct a business on the rental premises? YES / NO ..................................................................................................................
Do any of the applicants require bulky tools of the trade to be stored or parked on the premises? YES / NO ...................................................................................
Have any of the applicants been issued a claim at the magistrates court in regards to the residential tenancies act 1987 (WA)? YES / NO ........................................
If yes what reason?

38.

Special conditions that will apply to the lease (if Application accepted, and option exercised)

39.

100 Point Identification Check - The following identification has been photocopied / scanned / photographed and is attached to this application.
Applicant

Drivers Licence
Passport
Other Photo ID

Current Wage Payslip

Telephone Account (Fixed line only)

Electricity Account
Gas Account

40.

Return of option fee bank details if application is unsuccessful.

ACCOUNT NAME:...........................................................................................................................................................................................................
BANK NAME:...................................................................................................................................................................................................................
BSB:...................................................................................................................................................................................................................................
ACCOUNT NUMBER:.....................................................................................................................................................................................................

Applicants signature .......................................................................................................................................................Date ..............................................................

Applicants signature .......................................................................................................................................................Date .............................................................

Applicants signature .......................................................................................................................................................Date .............................................................
Owner or Owners Managing Agents signature ..............................................................................................................Date .............................................................
as acceptance of the Application
6

Approved by
The Real Estate Institute
Of Western Australia (Inc.)
FOR USE BY MEMBERS

Copy to Applicant Yes / No

Receipt No............................

COPYRIGHT REIWA 2001

(This page is not part of the Application)

OFFICE ONLY
Premises...................................................................................................................................................................................................................................................
Owner .....................................................................................................................................................................................................................................................
Applicant (1)...........................................................................................................................................................................................................................................
(2)..............................................................................................................(3).........................................................................................................................
Current Managing Agent/Owner report including details of any breaches. Amount of bond returned ?................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
Previous Managing Agent/Owner report including details of any breaches. Amount of bond returned? ................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
Pets: Yes/No Type and Number of Pets ................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
Gardens comments ..................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
Pool/spa comments..................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
Tenancy Database ...................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
If Applicant(s) is a new resident two work references from:
Copies sighted ................................/................................./ .............................
Employer phoned ............................../................................./..............................
Occupation confirmed

temporary

spoke to ......................................................................................................

part-time

permanent

Applicant(s) employed since ......................./......................./ .............................

Applicant(s) accepted by
......................./......................./ .............................
Reference check ................................................................................................
Owner Comments. .................................................................................................................................................................................................................................
.................................................................................................................................................................................................................................................................
Date of Owners Approval / Rejection......................................................................................................................................................................................................
Date Option granted to Applicant ............................................................................................ Date Option expires ............................................................................