APPLICATION FOR ACCOMMODATION

Property Address:

ACT

Applicants Mr Mrs Ms
Surname
Applicant's Given
names: (in full)
Number of persons who Adults
will occupy the premises
Pets
(please give details)
Applicant's
date of birth
Applicant's driver
Vehicle
license no.
reg. no.
and passport no.
Applicant's
occupation
Duration of
employment
Telephone no.
Employer/Dept
Salary/Income: (Gross per year)
Applicant $
Partner $
Current home address:
Rent paid $ /per week
How long there?

Partners
Surname
Partner's Given
names:
Children
Smokers(y/n)
Partners
date of birth
Partners drivers
license no.
Partners
occupation
Duration of
employment
Employer/Dept
Do you receive:

Previous address:
(if less than 3 years)
Name and address of last
or present landlord/agent:
Personal references - NOT RELATIVES or friends (Name and
1.
2.
Emergency contact (Name and Address)

DECLARATION

Mr Mrs

Vehicle
reg. no.

Telephone
no.
Disability Pension yes/no
Rent Relief yes/no
Telephone no. there
Rent paid $ /per week
Telephone no.
Addresses)
B/H telephone no.
A/H telephone no,
B/H telephone no.
A/H tel5phone no.
B/H telephone no.
A/H telephone no.

NOTE: This statement does not constitute a Tenancy Agreement

I

the Applicant, do solemnly declare that I am not a bankrupt, an

undercharged bankrupt nor a minor and have full capacity under the law to enter into a contract.
I the Applicant, have inspected the property listed above (physical visit or photographs), and should my application be successful,
agree to a pay security deposit and share house expenses in advance as requested.
I, the Applicant agree, that should this application be unsuccessful, or the property be found to be unavailable, I will make no claim or
demand nor commence litigation against the lessor or agent.
I do not intend to have a pet in or on the premises without permission in writing from the lessor or agent.
I affirm that the information I have provided is true and correct.
Declared at

this
(place)

day of
(day)

2014
(month)

(year)

Signature of Applicant
Witnessed by:

In order to provide the most suitable environment and cater for correct energy consumption, please answer the
following,
1.DO YOU SMOKE?
2. DO YOU MOSTLY FRY YOUR FOOD IN THE KITCHEN? (FIRE SAFETY
QUESTION)
2a DO YOU PREFER TO MAKE YOUR OWN MEALS ALL THE TIME OR SHARE COOKING AND EXCHANGE
MEAL IDEAS REGULARLY?
3. DO YOU HAVE ANY DISABILITY AT ALL?
4. ARE YOU APPLYING FOR RENT ASSISTANCE?
5 WHAT MUSICAL INSTRUMENT DO YOU PLAY?
6 ARE YOU, SINGLE, MARRIED, DATING, HAVE CLOSE FRIEND?
7 WILL YOU HAVE OVERNIGHT VISITORS? Ie FAMILY/FRIEND?
8 DO YOU HAVE LOUD STEREO SPEAKERS?
9 HOW LONG DO YOU INTEND TO STAY?
10 HOW DO YOU RATE PRIORITY IN KEEPING THE PLACE CLEAN
AND TIDY? DAILY, WEEKLY, SOMETIMES
11 HOW DO YOU RATE GARDENING CHORES? DAILY, WEEKLY, NEVER
12 DO YOU INTEND TO TAKE OUT PERSONAL CONTENTS INSURANCE?
13 WHAT IS YOUR AGE?
14 HAVE YOU BEEN TO COURT OR TRIBUNAL BEFORE?
15 WHAT IS YOUR ETHNIC BACKGROUND?
16 WHAT ARE YOU STUDYING/WORK?
17 ARE YOU ALLERGIC TO ANIMALS?
18 HOW OFTEN DO YOU NEED TO USE THE WASHING MACHINE?
19 DO YOU HAVE PARTIES AT HOME? IF SO HOW OFTEN?
20 DO YOU WEAR SHOES INSIDE THE HOUSE? ALLWAYS, NEVER, SOMETIMES
23 DO YOU HAVE THE SHOWER IN THE 'MORNING' OR 'NIGHT'?
24 DO YOU KEEP TO YOURSELF AND NEED MORE PRIVACY OR DO YOU JOIN IN
CONVERSATIONS AND OUTINGS ETC WITH OTHER FLATMATES.
25. DO YOU PLAY SPORT?
26 WOULD YOU BE INTERESTED IN OCCASIONAL SHOPPING AS A TEAM?
27. DO YOU CONSUME ALCOHOL? IF SO HOW MANY DRINKS AT A TIME?
28. HAVE YOU EVER HAD TO CLEAN OUT RANGEHOOD ABOVE THE STOVE?
29. HAVE YOU EVER CLEANED THE OVEN?
30. DO YOU HAVE ANY HOME MAINTENANCE EXPERIENCE?