Application For Rental Accommodation
FULL NAME:
CURRENT ADDRESS:
PREVIOUS ADDRESS:
EMAIL ADDRESS:
CONTACT PHONE:
DATE OF BIRTH:
Vehicle Registration No:
Drivers Licence No (5a):
Card Version No (5b):
Current Landlord:
Phone:
I require a:
House
Flat
with:
1
2
3
4
bedrooms
No of intended occupants:
Adults
plus
Children
Name and DoB of other adults:
Rent per week not to exceed:
Locality preferred:
Do any of the intended occupants smoke?
Yes
No
Do you have pets?
Any other Requirements:
I declare that the information given is true and correct and that the Landlord/Agent may check on any details
I agree to any of the information supplied being given to another Landlord/Agent
I authorise any person or company to provide Mid North Real Estate Ltd with such information as Mid North Real Estate Ltd may reasonably require in response to Mid North Real Estate Ltd credit enquiries. Credit check enquiries will include a Ministry of Justice Overdue Fines Balance Search.
I agree that the Landlord/Agent may use any of the information on this application to enforce any judgement or money order obtained against me
I authorise the Landlord/Agent to obtain information against me from the Tenancy Services, any electronic tenant screen agency, any postal authority, any power supply company, or any telecommunications company
I declare that this authority cannot subsequently be cancelled by me
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