Application Form
For your application to be processed you must answer all questions
(including the reverse side)
A. AGENT DETAILS
D. UTILITY CONNECTIONS
Richardson&&Wrench
WrenchMaroubra
Leichhardt
Richardson
185 Marion Street LEICHHARDT
Address:
Phone
Phone No:
no.
FaxNo:
no.
Fax
Email address:
Email:
Web:
ABN:
NSW 2040
180 Maroubra Road, MAROUBRA NSW 2035
02 8347 5000
02 9569 6600
02 9560 7717
02 8347 5099
[email protected]
[email protected]
www.randw.com.au/maroubra
36 097 538 540
If you would like assistance, (at no additional charge) with the connection
of telephone, electricity and gas (if applicable) to your new home then
tick the box below. Richardson & Wrench Connect will then contact you
and explain the details of the services available. Richardson & Wrench
Connect also provide a range of additional services to compliment your
household utilities, such as Internet & Pay TV.
Please contact me regarding CONNECTION of my utilities
I have received the AGL Offer Terms, AGL General Terms
and Customer Written Acknowledgement
B. PROPERTY DETAILS
Utility connection services are provided by
1.
What is the address of the property you would like to rent?
Phone: 1300 554 323
Fax: 1300 889 598
Postcode
2.
3.
4.
Lease commencement date?
Day
Month
Year
Years
Months
Lease term?
I hereby offer to rent the property from the owner under a lease to be
prepared by the Agent. I acknowledge that I will be required to pay the
amounts as specified in Section J. 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 applicant, further acknowledge that I will make
no claim or demand on nor commence litigation against the lessor or his
agent should the premises be found to be unavailable due to the
occupation by another occupier.
How many people will normally occupy the property?
Children
C. PERSONAL DETAILS
Please give us your details
Mr
Ms
Miss
Surname
Mrs
Other
Given name/s
Date of Birth
Driver’s license no.
Driver’s license state
Passport no.
Passport country
Pension type (if applicable)
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.
Please provide your contact details
Home phone no.
Mobile phone no.
Work phone no.
Fax no.
Email address
7.
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;
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 organizations / 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)
Pension no. (if applicable)
6.
Richardson & Wrench Connect is powered by ConnectNow.
A ConnectNow representative will make all reasonable efforts to contact
you within One working day of receiving an application. If ConnectNow
was unable to contact you within this period please contact ConnectNow
on 1300 554 323 to ensure connection is completed.
E. DECLARATION
Adults
5.
Email: [email protected]
Web: www.connectnow.com.au
What is your current address?
Postcode
If Section D is completed, I consent to ConnectNow Pty. Ltd. A.B.N. 79 097 398
662 arranging for the connection and disconnection of the nominated home
services and to provide information contained in this application to the service
providers for this purpose. I agree that neither ConnectNow nor the Agent
accepts liability for loss caused by delay in, or failure to connect/disconnect or
provide the nominated services. The service will be activated according to the
applicable regulations, service provider time frames and terms and conditions
once the client has agreed to use the chosen service provider. I authorise the
obtaining of a National Metering Identifier (N.M.I.) and/or Delivery Point Identifier
(D.P.I) on my residential address to obtain supply details. I consent to
ConnectNow disclosing confirmation details (including suppliers, NMI, MIRN, new
telephone number, water company) to the Agent. I acknowledge that the terms
and conditions of the service provider bind me and that after hours connections
may incur additional service fees from service providers. I acknowledge that
ConnectNow Pty Ltd will be paid a fee by the service provider and will be paying
a fee to the Agent in respect of the provision of the service being provided to me
by ConnectNow Pty Ltd. There is no charge for the ConnectNow service; normal
service provider fees or bonds may apply. Where applicable, I consent to Sholl
Communications arranging for the connection and disconnection of the
nominated telephony services and products and agree to be bound by the terms
and conditions of Sholl Communication and their agents and or suppliers. I
agree that neither Sholl Communications nor their agents or suppliers accepts
liability for loss caused by delay in, or failure to connect or provide the nominated
product or service.
Signature
Date
x
N.B. Both sides of this application must
be completed
Property manager name
Application faxed to
ConnectNow (if required)
Koxan Oey
# 5476
F. APPLICANT HISTORY
8.
Years
9.
17. Please provide two personal references (not related to you)
1. Surname
Given name/s
How long have you lived at your current address?
Months
Why are you leaving this address?
10. Agent/Landlord details of this property (if applicable)
Name of landlord or agent
Landlord/agent’s phone no.
Relationship to you
Phone no.
2. Surname
Given name/s
Relationship to you
Phone no.
Weekly rent paid
$
I. OTHER INFORMATION
11. What was your previous residential address?
18. Car Registration
Postcode
12. How long did you live at this address?
19. Please provide details of any pets:
Years
Months
Breed / type
13. Agent/Landlord details of this property (if applicable)
Name of landlord or agent
Council registration / number
1.
2.
Landlord/agent’s phone no.
Weekly rent paid
J. PAYMENT DETAILS
$
Property rental
Was bond refunded in full?
If not why not?
$
G. EMPLOYMENT HISTORY
14. Please provide your employment details
What is your occupation?
Employer’s name (inc. accountant if self employed or institution if a student)
$
per week OR
per month
First payment of rent in advance
$
Rental bond (4 weeks rent)
$
Tenant’s share of cost of preparing tenancy agreement
$
Sub Total
$
Less: deduct Reservation Fee (see below)
$
Amount payable on signing tenancy agreement
(cash or bank cheque only)
$
Employer’s address
K. RESERVATION
Complete this section if you wish to reserve the property for a period of time:
Postcode
RESERVATION FEE
Contact name
LEASE PERIOD
Phone no.
$
Length of employment
Years
Net income?
Months
$
15. Please provide your previous employment details
Occupation?
Employer’s name:
Length of employment
The Landlord’s Agent undertakes:
(a) the whole fee will be refunded if the landlord does not decide
to enter into a residential tenancy agreement for the premises
during the Reservation Period;
(b) if the Applicant decides not to enter into a residential tenancy
agreement, and the premises are not let or otherwise occupied
during the Reservation Period, the landlord may retain the
portion of the fee representing the rent that would have been
paid during the Reservation Period (based upon the proposed
rent), but must refund the remainder; and
(c) if a residential tenancy agreement is entered into, the fee is to
be contributed towards rent for the premises.
Net income?
Carspace/Garage
Years
Months
H. CONTACTS / REFERENCES
Lease Start Date
$
Landlord’s Name
16. Please provide a contact in case of emergency
Surname
Given name/s
Relationship to you
Phone no.
Lease to be signed on
Signature of Tenant
X
Date