Residential Tenancy Application Form
For your application to be processed you must answer all questions
(including the reverse side & supplying copies of 100 point ID)
Phone:
1300 554 323
Email: .au
Internet:
Bekdon Richards
Address:
Level 1 Suite 2, 205-207 Riversdale Road, Hawthorn
A free service – Connecting Your Utilities Has Never Been Easier
Phone:
03 9815 2999
Connectnow is a simple and convenient time saving service assisting your Electricity, Gas,
Fax:
03 9815 2988
Phone, Internet and Pay-TV connections to some of Australia’s leading providers.
Email:
.au
This is a value-added service independent of your tenancy application—you are not
obligated to use connectnow.
What is the address of the property you would like to rent?
If you would like connectnow to contact you to discuss any of the above services
please tick the box and 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
Postcode
to ensure connection is completed by your requested date.
It is the responsibility of the Tenant to ensure that the Main Electricity Switch is in
Have you inspected the property? (Please tick if YES)
the “Off Position” between 7am & 7pm on the day connection is required and that
there is easy access to the property.
Lease commencement date?
Lease term?
While the connectnow service is FREE, standard service provider connection fees and
charges still apply.
dd/mm/yy
Years
Months
You pay NO extra charges as a result of using the connectnow service.
Call me to connect my utilities
Yes
Property Rental?
$
per week OR $
per month
Property Manager:
How many people will normally occupy the property?
Adults
Children
Ages of Children
A) I acknowledge that this is an application to lease this property and that my application is subject
to the owner’s approval and the availability of the premises on the due date. I hereby offer to rent
the property from the owner under a lease to be prepared by the Agent pursuant to the Residential
Tenancies Act 1997. I acknowledge that I will be required to pay rental in advance and a rental
Please provide your details below
bond, and that this application is subject to approval from the owner/landlord. I declare that all
Mr
Mrs
Ms
Miss
Dr
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 authorise the
Given name/s
Surname
Agent to obtain details of my credit worthiness from, the owner or Agent of my current or previous
residence, my personal referees, 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 any person whom
Date of Birth
Driver’s licence number
the Agent reasonably considers has an interest receiving such information.
B) If section 5 is complete please note: Connection of your utilities will only be initiated once a
representative has discussed your details with you and obtained your consent to the terms and
Driver’s licence expiry date
Driver’s licence state
conditions of supply of the relevant utility service provider(s). The privacy of our customers is of
vital importance to connectnow. I consent to the collection of my personal information by
Connectnow Pty Ltd ACN 79 097 398 662 for the purposes of arranging for the connection and or
Passport no.
Passport country
disconnection of the nominated moving and connections services and related services, and to
providing my personal information contained in this application to the relevant service providers, in
accordance with Connectnow’s Privacy Policy (which is available for my inspection at
Pension Number (If applicable)
Pension Type (If applicable)
) Connectnow and those service providers may contact me from time to
time (including by electronic means) to let me know about new or existing products or services. I
understand that I can contact Connectnow at any time if I do not want to receive that information
from Connectnow or if I want to update my personal information. I agree that neither connectnow
Please provide your contact details
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
Home phone no.
Mobile phone no.
regulations, service provider time frames, terms and conditions once agreeing to use the chosen
service provider. I authorise the obtaining of a National Metering Identifier and or a Metering
Installation Registration Number on my residential address to obtain supply details. It is the
Work phone no.
Fax no.
responsibility of the customer/homeowner to ensure that the electricity main switch is in the ‘Off
Position’ for the required timeframe on the day of connection and that there is easy access to the
meters. 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
Email address
connectnow may be paid a fee by the service provider and may pay a fee to the Agent in respect of
the provision of the service provided to me by connectnow.
Secondary Email address
The information on this form is being collected by Bekdon Richards Pty Ltd (“we”/”us”). It is a
condition of application for a tenancy for any property managed by us, or in conjunction with other
agents, that you consent to us collecting and using your personal information. We require this
information so we can consider your application to rent a property.
We may provide this information and any or all information provided to us by any party to third
Please provide a next of kin/contact in case of emergency
parties including landlords, landlords’ agents and solicitors and various government or statutory
Given Name
Surname
authorities in the interests of openness and transparency between all parties concerned. We may
also contact personal and credit referees you nominate and exchange personal information
according to normal commercial practice. You authorise us to conduct a tenant check with National
Tenancy Database (“ntd”). Your information will be listed on the ntd and may be made available to
Relationship to you
Contact Number
other users or the ntd in the future. You may contact the ntd directly to verify the accuracy of the
information on the ntd and to request any amendments.
Email Address
Signature
Date