Rental Application Form

This information is provided by you for the purpose of assessing your eligibility as a tenant.

Property address *

Proposed tenancy start date *

Proposed tenancy period *

Full name *

Email address *

Phone

Mobile

Date of birth

Identification

Drivers License

5a 5b

Birth Certificate

Passport Number

Current address

How long have you lived
at this address?

List all other addresses where you have resided in the last 5 years plus how long in each:

Address 1	Address 2

Address 3	Address 4

List the current and 2 previous landlords/employers for reference:

Current landlord:
Name
Phone
Past landlord/employer:
Name
Phone
Address
Past landlord/employer:
Name
Phone
Address

Next of kin

Name

Relationship

Phone

Address

Employment

Income source

Current employer or tertiary institute

Position held

How long have you worked or studied there?

List the full names of anyone else who will be living with you in the property

List any pets
Cat, Dog etc.

If you or anyone else who will be residing at this address have any criminal convictions please state the nature of the conviction

All of our properties are non smoking inside:

We accept that we may not smoke inside any property we rent off Otago Property Management

Please note that the completion of this application form does not constitute an agreement to lease a property to the applicant. An agreement to lease will be reached when the landlord or his agent has accepted and issued a receipt for the bond and the first weeks rental payment.

"I / we authorise any person or company to provide you with such information as you may require in response to your credit and / or rental inquiries. I / we further authorise you to furnish any third party details of this application and any subsequent dealings that I / we may have with you as a result of this application being actioned by you."

I am aware that should I have supplied any false information pertaining to this application then this could result in the immediate termination of my rental contract.

If my application is successful then I consent to Otago Property Management Limited taking a digital photograph of myself and any other intended occupants / pets that may be intending to reside in the property to be held on their records for identification purposes.

Privacy Act 1993 Statement

For the purposes of this Privacy Act 1993;

This application collects personal information about you
This information is required to;
- Assess your eligibility as a tenant
- Collect information that would be provided to a tenant default database or credit bureau if you enter into a tenancy agreement and fail to comply with the terms of that agreement. (A Tenant default database records the names of persons who have been found to breach a Tenancy Agreement or the Residential Tenancies Act 1986 by the Tenancy Tribunal)
The information in this Tenant application form will, if you enter into a Tenancy Agreement with us, be held on a database and used by us and by the owner of the rented property.
Failure to provide any of the information requested may mean you will not be considered as a tenant for any of the properties within the Privacy Act.
You are entitled to access and correct this information that is held about you.

I agree to these terms & Conditions

Security code *

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the field below

We charge no letting fees to tenants or landlords.

Rental Application Form

Dunedin Mosgiel Brighton Taieri Mouth Waikouaiti Karitane Balclutha Milton Lawrence