Tenant Assessment Application Form (Page 4 of 5) in pdf

Bank / Building society details:

Name of Bank

Address of Branch

Account in Name of?

How long with this Branch?

Do you have a cheque guarantee card? Yes / No

(please circle)

Branch Sort Code

Account No.

Next of Kin:

Name

Address

Town

County

Postcode

Daytime Telephone

Mobile Number

Email Address

Relationship

Applicants Consent:

The information which I have given in my application form is true to the best of my knowledge. I consent to this

information being verified by fair and lawful means, which I understand will involve contacting referees and licensed

credit reference agencies.

I consent to Let Insurance Services searching information held by a credit reference agency and agree that Let

Insurance Services and the credit referencing agency will keep a record of the search and the results of the search. Such

information may be used by other companies for the purpose of assessing other applications from me or for debt

tracing and fraud prevention.

I understand the information supplied by me and the resulting verified information will be forwarded to the letting

agency and/or to the prospective landlord. The information may also be accessed again if I apply for a tenancy in the

future. I agree that information supplied by me and the results of the assessment process will be held in accordance

with the Company’s notification under the Data Protection Act 1998. I understand that I have the right to ask for a copy

of the information held on me subject to the payment of an administration fee that will be notified to me upon

application, though it will not exceed the amount set by statute. I have the right to request that the information held be

amended if it is found to be incorrect.

Let Insurance Services, as well as the letting agency and other selected businesses, may use this information to keep you

informed by post, telephone, email or other means about products and services that may be of interest. If you do not

want your information to be used for these marketing purposes, please signify by ticking the box.

Signature:

Date:

Signature:

Date:

The information contained within this application is being transmitted to and is intended only for the use of Let Insurance Services. If the reader is not the intended

recipient, you are hereby advised any dissemination, distribution or copy of this application is strictly prohibited. If you have received this application in error, please

immediately notify us by calling 0844 478 1600

LIS Tenant Assessment Application Fax Form – April 2011

Page 4 of 5