Bennison Mackinnon & Associates Pty Ltd - Amazon Web …
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1. Agent Details
Address: 72 Bridge Street, Benalla VIC 3672
Phone no: 03 5762 3322
Fax no: 03 5762 4334
Email: info@.au
Property Manager: Shylandi Lewis ID: 2711
2. Property Details
Address
Suburb Postcode
Lease Term Years Months
Date Property is to be occupied / /
Number of Applicants to Occupy the Property
Adults: Children: Ages:
3. Personal Details
Title First Name Initial
Last Name
Date of Birth / / Age (Years)
Drivers Licence Number State of Issue
Alternate ID (eg passport) No
Contact details
Current Address
Suburb Postcode
Home Ph Mobile Ph
Email
Occupation Work No
4. Emergency Contact
Please provide an emergency contact not residing with you
First Name Surname
Relationship Phone No
Address
Suburb Postcode
5. Social Security Benefits
Type $
Type $
Payment Cycle Weekly Fortnightly
Next payment Date / /
6. Utility Connections
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7. Declaration
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 Tenancy Agreement.
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, the tenant, accept the property in the condition it was in when inspected.
I authorise the Agent to obtain personal information about me from:
(a) The owner or the Agent of my current or previous residences;
(b) My personal referees and employer/s;
(c) Any record listing or database of defaults by tenants;
Any record listing or database of defaults by tenants such as TICA, NTD or TRA for the purpose of checking your tenancy history. I am aware that I may access my personal information by contacting:
TICA 1902 220 346
NTD 1300 563 826
TRA (02) 9363 9244
I am aware that the Agent will use and disclose my personal information
within this application in order to:
(a) communicate with the owner and select a tenant
(b) prepare lease/tenancy documents
(c) allow trades-people or equivalent organisations to contact me
(d) lodge/claim/transfer to/from a Bond Authority
(e) refer to Tribunals/Courts & Statutory Authorities (where applicable)
(f) refer to collection agents/lawyers (where applicable)
(g) complete a check with TICA
(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 which personal information is put, the Agent cannot provide me with the lease/tenancy of the premises. I am aware that I may access personal information on the contact details above.
Signed: Date / /
8. Applicant History
Do you own any Property? YES NO If Yes Where?
Current Residential Address: (As indicated in Section 3)
When did you move in to your current address? / /
Are you? Renting/ Boarding Own Property
If Renting or Boarding? Name of Landlord/Agent/Or Person you pay rent to:
Phone No:
Rent Paid Per Week $
Reason for leaving:
Previous residential address:
Suburb Postcode
Dates you lived at this address: / / to / /
Name of Landlord/Agent (If applicable):
Phone No:
Rent Paid per week $
Reason for leaving:
Did you receive any breach notices during your tenancy? Yes No
If Yes, please specify why:
Was the bond repaid in full? Yes No
If No, please specify why:
List your previous 2 addresses you have lived at with dates and contact details? (Excluding the above properties)
/ / to / /
/ / to / /
9. Other information
Do you have any vehicles? Yes No If Yes, how many:
Do you have pets? Yes No
If Yes, please specify type/breed and age:
10. If Student, please complete the following
Place of Study
Course being undertaken
Course Length
Enrolment Number
Campus Contact Ph
Course Co-ordinator Ph
11. Current Employment Details
Occupation
Employers Name
Employment Address
Suburb Postcode
Employer Phone No
Contact Name
Start of employment / /
Full Time Part Time Casual (Please Circle)
Net Income $ Per Week / Fortnight / Month (Please Circle)
12. Previous/Other Employment Details
Occupation
Employers Name
Employment Address
Suburb Postcode
Employer Phone No
Contact Name
Dates of employment / / to / /
Net Income $ Per Week / Fortnight / Month (Please Circle)
13. Professional / Character Referees
1. Reference name
Occupation
Relationship Phone No
Notes
1. Reference name
Occupation
Relationship Phone No
Notes
APPLICATIONS FOR TENANCY
PRIVACY ACT 1988
COLLECTION NOTICE
The personal information the prospective tenant provides in this application or that which is collected from other sources is necessary for the Agent to verify the Applicant’s identity and to process and evaluate the application. The personal information collected about the Applicant may be disclosed for the purpose for which it was collected, to other parties, including the landlord, referees, financial institutions, other agents, third party operators of tenancy reference databases may also be disclosed to the Agent and/ or landlord. The Agent may also disclose information to other parties on the internet.
The Agent will only disclose information in this way to other parties to achieve the purposes specified above or as otherwise allowed under the Australian Privacy Principles & the Privacy Amendment Act 2012.
If the applicant would like to access his/her personal information held by the Agent, they can do so by contacting the Agent at the address and contact numbers contained in this Application. The Applicant can also correct this information if it is inaccurate, incomplete or out of date.
In the event that your application is unsuccessful your information will be destroyed by us.
Property Address:...................................................................................................
Applicant’s Name: .................................................................................................
Applicant’s Signature: ...........................................................................................
Date:....................................
A full hard copy of our Privacy Policy is available in our office or online at
To allow us to complete your application please ensure the following documents are attached or provided with your application:
( Completed Application form/s
(Any adults over the age of 18 y/o that will be residing at the property are required to complete their own application – this includes any persons not going on the lease)
( Copy of Drivers Licence or Photo ID
( Copy of Medicare Card and/or Pension Card
( Copy of proof of income
These may include any or all of the following:
• Centrelink statements
• Wage slips
• Bank statements
( Written rental references (if applicable)
( Rental payment history (if applicable)
-----------------------
Residential Tenancy Application Form
For your application to be processed you must answer all questions
(Including the reverse side)
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