
Tenant Registration Form Please note that all fields are requested to be completed - If a field is not applicable write "N/A"

Your Full Name *

Date of Birth *

Current Address *

How Long at this address? *

Home Phone *

Mobile *

Email Address *

Reason for leaving this address? *

Current Landlord *

Current Landlord Phone *

Previous Rental Address *

Previous Landlord Name *

Previous Landlord Phone *

Your Occupation(s) *

Your Employer(s) *

Employer(s) Phone *

Partners Name *

Partners Occupation(s) *

Partners Employer(s) *

Partners Employer(s) Phone *

Who will be living with you (Names) *

How old are the children living with you? *

Pets (State Breed of Dog) *

Smokers? *	Yes No

Identification

Drivers License *

Passport Number *

WINZ Number *

Car Registration *

Please supply the name, address and phone number of someone we can contact about your tenancy if for any reason we cannot contact you – i.e. parent, trustee or close relation.

Contact Person name & Phone *

REQUIREMENTS

Number of Bedrooms required *

Weekly Rent Sought $ *

Type of Dwelling *	House Flat Garaging

Area Preferred *

Rental Term *	Long Term Short Term

Preferred Start Date *

Other Requirements *

NB. If you do not supply all information requested in this form you may not be considered for any rental properties available through Home Rental Services.

Signed (Print Your Full Name) *

Date *

I hereby confirm that the information contained in this form is true and correct and that I have read the Privacy Act Statement on the previous page.