Residential Application Form

ABN: 12 238 870 391
WEBSITE: www.nicholsonre.com.au
EMAIL: rentals@nicholsonre.com.au

Brunswick East Office

Address: R1/21 Brunswick Road, BRUNSWICK EAST 3057

Phone No: 03 9387 0966      Fax No: 03 9380 1985

Reservoir Office

Address: 290 Broadway, Reservoir 3073

Phone No: 03 9460 2541      Fax No: 03 9460 2011

Tick applicable office & use the coinciding contact details to submit your application

1. Address of Property?

2. Lease commencement date?

Day
Month
Year

3. Lease term?

Year
Month

4. How many tenants will occupy the property?

Adults
Children
Children Ages

5. How did you find this property?

6. Please give us your details.

MrMsMissMrsOther

Surname
Given name/s

Date of Birth
Driver's licence number

Driver's licence expiry date
Driver's licence state

Passport number
Passport country

Pension number (if applicable)
Pension type (if applicable)

7. Please provide your contact details.

Home phone number
Mobile phone number

Work phone number
Fax number

Email address

8. What is your current address?

Moving made easier

Connectnow makes moving easier for you by sorting your essential home moving needs quickly and easily in one simple phone call. Our services include 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 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 from us, please call 1300 554 323 to ensure your services are connected.

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 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) may have their own Privacy Policy, which you can request from them. You consent to connectnow continuing to market to you unless you opt out, including by emailing info@connectnow.com.au. 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 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 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 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.

Yes, I accept the Terms. Please call me to connect my new services.

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 into a Residential Tenancies Agreement pursuant to the Residential Tenancies Act 1997.

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 authorise the Agent to obtain personal information from:

• (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.

I am aware that I may access personal information by contacting:

• NTD: 1300 563 826

• TICA: 1902 220 346

• 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 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

• (b) prepare lease/tenancy documents

• (c) allow organisations/tradespeople to contact me

• (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 1300 563 826- Email info@ntd.net.au)

• (h) transfer water account details into my name

I authorise the disclosure of information in my application to connectnow for the purpose of contacting the relevant water service provider to transfer the property’s water account to my name if my application is successful.

Signature
Date

Property Manager:

Application faxed to On The Move (if required).

9. How long have you lived at your current address?

Years
Month

10. Why are you leaving this address?

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

Name of landlord or Agent

Landlord/Agent's phone number
Weekly rent paid

12. What was your previous residential address?

13. How long did you live at this address?

Years
Month

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

Name of landlord or Agent

Landlord/Agent's phone number
Weekly rent paid

Was bond refunded in full?
if NO, why not?

YESNO

15. Please provide your employment details.

What is your occupation ?
What is the nature of your employment? (Please circle)
FULL-TIMEPART-TIMECASUAL
Employer's name (accountant if self-employed or institution if a student)
Employer's Address (accountant if self-employed or institution if a student)

Contact Name
Phone Number

Length of employment
Net income

Years
Months

16. Please provide your previous employment details.

Occupation
Employer's Name

Length of employment
Net income

Years
Months

17. Please provide a contact in case of emergency.

Surname
Given name/s

Relationship to you
Phone number

18. Please provide two personal References (not related to you).

1. Surname
Given name/s

Relationship to you
Phone number

2. Surname
Given name/s

Relationship to you
Phone number

19. Car Registration.

20. Please provide details of any pets.

Breed/ type
Council Registration/ number

21. Are you a smoker?

YESNO

Place of study

Course being undertaken

Course length

Enrolement Number

Parents Address Overseas

First Name

Surname

Relationship

Phone no

Address

Suburb
Postcode

Please note your application will not be processed without the checklist completed.

If all the requested information is listed and the checklist is completed, applications can be processed immediately. To assist us with checking your references please notify the said people of your application.

Have you applied for any other properties? Please tick what preference this property has.