Tenancy Application Form - Guardian (Page 2 of 4) in pdf

Residential Application Form

For your application to be processed you must answer all questions

(Including the reverse side)

AGENT DETAILS

UTILITY CONNECTIONS

Guardian Realty

This is a free service that connects all your utilities

Address:

534 Old Northern Road, Dural NSW 2158

Phone Number:

(02) 9651 1666

Fax Number:

(02) 9651 1555

Direct Connect will make all reasonable efforts to contact you within 24 hours of the nearest working

Email Address:

.au

of the services offered. Direct Connect is a utility one stop connection service.

Web:

Please tick utilities as required

Property Manager

Electricity

Gas

Phone

Internet

Insurance

Pay TV

PROPERTY DETAILS

1. What is the address of the property you would like to rent?

DECLARATION AND EXECUTION: By signing this application, I/we: consent to Direct Connect

arranging for the connection and disconnection of the nominated utility services and to providing

information contained in this application to utility providers for this purpose; acknowledge having been

provided with terms and Conditions of Supply of Direct Connect and having read and understood them

together with the Privacy Collection Notice set out below; declare that all the information contained

Postcode

in this application is true and correct and given of their own free will; expressly authorise Direct

Connect to provide any information disclosed in this Application to a supplier or potential supplier of

the Services in accordance with the Privacy Collection Notice and to obtain any information necessary

2. Lease commencement date?

in relation to the Services; expressly authorise Direct Connect to provide any information disclosed in

this Application to an information provider for the purpose of that information provider disclosing it to

Day

Month

Year

a supplier or potential supplier of the Services in accordance with the Privacy Collection Notice and

to obtain any information necessary in relation to the Services; consent to Direct Connect contacting

me by telephone or by SMS in relation to the marketing or promotion of all of the services listed

3. Lease term?

under the heading “Utility Connections” above even if we/I have not applied for the connection of

those services in this application. This consent will continue [for a period of 1 year from the date

of our/my execution of this application/until [28] days after we/I disconnect the last of the

Years

Months

services in respect of which this application is made]; acknowledge that this consent will permit

Direct Connect to contact us/me even if the telephone numbers listed on this application form are

listed on the Do Not Call Register; understand that under the requirements of the Privacy Act 1988,

4. How many tenants will occupy the property?

Direct Connect will ensure that all personal information obtained about me/us will be appropriately

Ages of

collected, used, disclosed and transferred and will be stored safely and protected against loss,

Adults

Children

to Direct Connect disclosing my/our details to utility providers (including my/our NMI and telephone

PERSONAL DETAILS

number); declare and undertake to be solely responsible for all amounts payable in relation to the

5. Please give us your details

Services; acknowledge that, to the extent permitted by law, Direct Connect shall not be liable for any

Miss

Mrs

Other

any property as a result of the provision of the services or any act or omission by the utility provider

Surname

Given Name/s

or for any loss caused by or in connection with any delay in connection, disconnection or provision

of, or failure to connect or disconnect or provide, the nominated utilities; acknowledge that whilst

Direct Connect is a free service I/we may be required to pay standard connection fees or deposits

required by various utility providers; acknowledge that the Services will be provided according to

the applicable regulations and that the time frames and terms and conditions of the nominated

Date of Birth

Driver’s licence number

utility providers bind me/us and that after hours connections may incur additional service fees from

utility providers; acknowledge that the real estate agent listed on this application form may receive

me/us by Direct Connect; and acknowledge the entitlement of Direct Connect and its associates,

agents and contractors, to receive a fee or remuneration from the utility provider and that such fee

Driver’s licence expiry date

Driver’s licence state

or remuneration will not be refunded to me as a rebate in connection with the provision of the utility

connection services.By signing this application form, I warrant that I am authorised to make this

application and to provide the consents, acknowledgements, authorisations and other undertakings

set out in this application form on behalf of all applicants listed in this application form.

Passport no.

Passport country

Signature

Date

Pension no. (if applicable)

Pension type (if applicable)

PO Box 1519, Box Hill, Victoria 3128. P: 1300 664 715 F:1300 664 185.

DECLARATION

I hereby offer to rent the property from the owner under a lease to be prepared by the Agent. Should

BSB

Account Number

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.

6. Please provide your contact details

I authorise the Agent to obtain personal Information from:

Home phone no.

Mobile phone no.

(a) The owner or the Agent of my current or previous residence;

(b) My personal referees and employer/s;

If I default under a rental agreement, I agree that the Agent may disclose details of any such

Work phone no.

Fax no.

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

Email address

(b) prepare lease/tenancy documents

(d) lodge/claim/transfer to/from a Bond Authority

(e) refer to Tribunals/Courts & Statutory Authorities (where applicable)

7. What is your current address?

(f) refer to collection agents/lawyers (where applicable)

(g) complete a credit check with TICA (Tenancy Information Centre Australia)

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

Postcode

that I may access personal information on the contact details above.

Signature

Date

Newspaper

The Internet

Local Paper

Sign Board at property

Application Fax to

Fax: 1300 664 185

Direct Connect (If Required)

Referral

Other (specify)

Tenancy Application Form - Guardian Page 2

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