Residential Application Form

For your application to be processed you must answer all questions

(including the reverse side)

A. AGENT DETAILS D. UTILITY CONNECTIONS

CENTURY 21 Property Group P: 1300 554 323 | F: 1300 889 598
E: [email protected]
280 Clayton Road, Clayton VIC 3168
Moving made easier
W: connectnow.com.au
Phone: 03 9544 8888
Connectnow makes moving easier for you by sorting your essential home
Fax: 03 9544 8870 moving needs quickly and easily in one simple phone call. Our services include
Email: [email protected] electricity, gas, internet, pay TV, home phone connections and much more. Plus,
our home moving service is free – it’s our way of ensuring your move is as
Property Manager: seamless as possible.
We’ll attempt to contact you within 1 working day of receiving this
application to provide you with our connection service. If you don’t hear
B. PROPERTY DETAILS from us, please call 1300 554 323 to ensure your services are connected.

1. What is the address of the property you would like to rent? PRIVACY CONSENT AND TERMS. By signing this form you consent and agree to
the following: Connect Now Pty Ltd (ABN 79 097 398 662) (“connectnow”) will collect, use
and disclose your personal information to contact you (including electronically) about
providing moving, connection and disconnection services and to inform you about
products and services offered by its related companies and third-party suppliers.
These other companies may also use your details to contact you directly about their
Postcode products and services. See connectnow’s Privacy Policy for further details, including
your rights to access and correct the information held about you at
connectnow.com.au. Third-party service providers (who may transfer your data overseas)
2. Property Rental? may have their own Privacy Policy, which you can request from them. You consent to
per per Bond connectnow continuing to market to you unless you opt out, including by emailing
$ week $ month $ [email protected]. To the extent permitted by law and except where expressly
guaranteed, connectnow are not responsible or liable for delayed or failed connections or
the service providers’ connection charges, which you must pay to them directly. Connectnow
3. Lease commencement date? may receive commissions or fees from your selected retailer(s), and your real estate agent
may also receive commissions or fees from connectnow, in each case for arranging provision
of the requested services. The value of commissions or fees may vary from time to time and
Day Month Year may differ depending on which retailer is selected. If you nominate an alternative
contact person on this application, you authorise them to act on your behalf to arrange
moving, connection and disconnection services , including accepting third-party terms. You
4. Lease Term? warrant that you are authorised to make this application on behalf of all applicants and
alternative contact persons listed and that each person has consented and agreed to the
handling of their personal information on the same terms as you have.
Years Months
Yes, I accept the Terms. Please call me to connect my new services.
5. How many people will normally occupy the property?
Signed: Date:
Adults Children, Ages: ____________________________ E. DECLARATION
I hereby offer to rent the property from the owner under a lease to be prepared
C. PERSONAL DETAILS by the Agent. Should this application be accepted by the landlord I agree to enter
into a Residential Tenancies Agreement pursuant to the Residential Tenancies Act
6. Please give us your details. 1997.
Mr Ms Miss Mrs Other I acknowledge that this application is subject to the approval of the
Given Name/s Surname 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 authorise the Agent to obtain personal information from:
Date of Birth Driver’s licence number
(a) the owner or the Agent of my current or previous residence;
(b) my personal referees and employer/s;
(c) any record, listing or database of defaults by tenants such as NTD, TICA
or TRA for the purpose of checking your tenancy history.
Driver’s licence expiry date Driver’s licence state
I am aware that I may access personal information by contacting:
NTD: 1300 563 826
TICA: 1902 220 346
Passport number Passport country TRA: 02 9363 9244
If I default under a rental agreement, the Agent may disclose details of any such
default to a tenancy default database, and to agents/landlords of properties I may
Pension number (if applicable) Pension Type (if applicable) apply for in the future.
I am aware that the Agent will use and disclose my personal information in order
to:
(a) communicate with the owner and select a tenant
7. Please provide your contact details. (b) prepare lease/tenancy documents
(c) allow organisations/tradespeople to contact me
Home phone number Mobile phone number
(d) lodge/claim/transfer to/from the Residential Tenancies Bond Authority
(e) refer to Tribunals/Courts & Statutory Authorities (where applicable)
(f) refer to collection agents/lawyers (where applicable)
(g) complete a credit check with NTD (National Tenancies Database - Phone
Work phone number Fax number
1300 563 826 – Email [email protected])
(h) transfer water account details into my name
I am aware that if information is not provided or I do not consent to the uses to
Email address which personal information is put, the Agent cannot provide me with the
lease/tenancy of the premises.
Signature
8. What is your current address? X
Print Name Date
Postcode
 F. APPLICANT HISTORY H. CONTACTS / REFERENCES
9. How long have you lived at your current address? 17. Please provide a contact in case of emergency.

Years Months Surname Given name/s

10. Why are you leaving this address?

Relationship to you Phone number

11. Landlord/Agent details of this property (if applicable).

18. Please provide two personal references (NOT RELATED TO YOU).
Name of landlord or agent 1. Surname Given name/s

Landlord/agent’s phone number Weekly rent paid Relationship to you Phone number
$

12. What was your previous residential address? 2. Surname Given name/s

Postcode
Relationship to you Phone number

13. How long did you live at this address?

Years Months I. OTHER INFORMATION

19. Please provide details of any vehicles.
14. Landlord/Agent details of this property (if applicable).
Registration number Make/model
Name of landlord or agent

Landlord/agent’s phone number Weekly rent paid 20. Please provide details of any pets.
Breed/Type Council registration / number
$
1.
Was bond refunded in full? If NO, why not?
2.
YES NO

J. IF STUDENT PLEASE COMPLETE

G. EMPLOYMENT HISTORY Place of study
15. Please provide your employment details.
What is your occupation?
Course being taken

What is the nature of your employment? Course length Enrolment number

(FULL-TIME / PART-TIME / CASUAL)

Employer’s name (inc. accountant if self-employed or institution if a student) Course coordinator Course coordinator phone

Employer’s address ** PLEASE NOTE**

Your application for tenancy cannot be accepted unless all sections are
completed and signed.
Initial payments must be made by cash, bank cheque or money order within 24
Postcode
hours after approval of application. No Personal Cheques accepted.
Contact name Phone number
Each applicant is required to submit a completed application
Identification – Current Drivers Licence (both sides) or Passport
Proof of Income – Current payslip or Centrelink statement
Length of employment Net Income (PA) Conditions of Residency – Visa Application or Letters of Scholarships

Years Months $ Keys will not be handed over until the lease agreement has been signed by all
applicants.
16. Please provide your previous employment details.
Occupation Applicant/s must make payment of bond within 24 hours by EFT, cash or bank
cheque
Applicant/s must sign lease documentation within 48 hours

Employer’s name PLEASE PROVIDE US WITH 100 POINTS OF IDENTIFICATION

Length of employment Net Income (PA)

Years Months $