The following Application Form asks you to supply some details about yourself. The most important aspect of the application is that you demonstrate your ability to pay the rent and preserve the home. If your application is successful we will make a time for you to read and sign the Tenancy Agreement. You will need to allow about an hour for this appointment. Costs associated with the arrangements are:
The personal information the prospective tenant provides in this application or collected from other sources is necessary for the Agent to verify the Applicant's identity, to process and evaluate the application and to manage the tenancy. Personal information collected about the Applicant in this application and during the course of the tenancy if the application is successful may be disclosed for the purpose for which it was collected to other parties including to the landlord, referees, other agents and third party operators of tenancy reference databases. Information already held on tenancy reference databases may also be disclosed to the Agent and/or Landlord. If the applicant enters into a residential tenancy agreement, and if the applicant fails to comply with their obligations under that agreement, that fact and other relevant personal information collected about the applicant during the course of the tenancy may also be disclosed to the landlord, third party operators of tenancy reference databases and/or other agents.
If the applicant would like to access the personal information the Agent holds, they can do so by contacting Bertram Ellis at 10/16 Brierly Street, Weston, ACT on 6288 3999 or by fax 6288 2922 or by e-mail to property@bertramellis.com.au . The Applicant can also correct this information if it is inaccurate, incomplete or out-of-date. If the information is not provided, the Agent may not be able to process the application and manage the tenancy.
Property Address
Rent per week
Date Required
Person to occupyAdults Children
Term of lease
PetsYes/No Type
Full Name
Date of Birth
Present Address
Work Phone
Home Phone
Mobile
Email
Driver's Licence State
Employment Position
Company Name
Length of Employment
Employer Contact Name
Employer Phone
Name
Address
Are you currently Renting Own Home Living at Home
Agent/landlord
Agent's Phone
Current Rental
Length of Current Rental
If less than 3 yrs, previous agent
Previous address
Please supply two referees (References from relatives and employers are unacceptable)
Name Phone
I have been advised I may obtain a copy of the Renting Book from the ACT Office of Fair Trading website: www.fairtrading.act.gov.au
I, the applicant, do solemnly and sincerely declare that I am not a bankrupt or an undischarged bankrupt and that I am at least 18 years of age. I have inspected the above mentioned premises and wish to take a tenancy for such premises for a period of months, at a rental of $ and confirm that the rental to be paid is within my means.
I have read the Privacy Collection Notice above and give permission for Bertram Ellis to contact people named in this application.
I will respect the owners request not to smoke in the property.
I do not have nor intend to have a pet in or on the premises without written permission from the landlord or his agent.
Agree to the above Yes No
Note: fields marked with a bold label are required to submit this form.
