Residential Application Form

For your application to be processed you must answer all questions

(including the reverse side)

A. AGENT DETAILS D. UTILITY CONNECTIONS

Telephone: 1300 400 600
Fax: 1300 326 468
www.yourporter.com.au

YourPorter is a FREE service connecting utilities and other services.

If the Agent approves this application, YourPorter will be contacting you by
phone, SMS, or email for the purposes of assisting you to connect your utilities
within 24 hours of receiving this application for next business day connection.

Address: PO Box 345, Forestville NSW 2087

Electricity Telephone Pay TV
Phone: 0404 703 541
email: Adam@Adam-Rizk.com Gas Internet Health Insurance

Car Insurance Home Loans

Life Insurance Home & Contents Insurance
B. PROPERTY DETAILS
DECLARATION AND ACCEPTANCE:
1. What is the address of the property you would like to rent? I/We consent to the disclosure of this application form (including any personal information
contained in this form) to YourPorter Pty Ltd (ABN 36 252 576 050) for the purpose of
allowing YourPorter and its service providers to contact me for the connection of services
as offered by YourPorter.
Postcode
I/We acknowledge that if I/We do not provide my/our personal information, YourPorter will
not be able to provide these services to me/us. YourPorter will ensure that my/our
2. Lease commencement date? personal information is collected, used, held and disclosed in accordance with the
requirements of the Privacy Act 1988 (Cth).
Day Month Year I/We acknowledge that YourPorter may receive a benefit in relation to the connection of
any of the services listed above. I/We consent to YourPorter contacting me by phone or
3. Lease term? SMS in relation to the connection of the services listed above. I/We acknowledge that this
consent permits YourPorter to contact me even if the numbers listed on this application
Years Months are listed on the Do Not Call Register. YourPorter will otherwise collect, hold, use and
disclose personal information in accordance with their privacy policies, which are available
4. How many tenants will occupy the property? at www.yourporter.com.au/general/privacy-policy/.YourPorter is a free service, but l/We
acknowledge that standard connection fees may apply for services connected (in addition
Ages of to the ongoing service fees).
Adults Children
Children
I/We acknowledge that neither YourPorter nor the Agent accept any responsibility for any
delay in or failure to arrange or provide for any connection of a service or for any loss,
C. PERSONAL DETAILS damage, cost or expense in connection with such delay or failure. By signing this
application, I/We understand YourPorter is a value add product and that I/We are under no
5. Please give us your details obligation to use YourPorter.

Mr Ms Miss Mrs Other

Signature of The Applicant Date
Surname Given name/s
X / /
E. DECLARATION
Date of Birth Driver's licence number
I hereby offer to rent the property from the owner under a lease to be prepared by the
/ / Agent. Should this application be accepted by the landlord I agree to enter into a
Residential Tenancy Agreement.
Driver's licence expiry date Driver's licence state 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.

Passport no. Passport country I authorise the Agent to obtain personal information about me from:
(a) The owner or the Agent of my current or previous residences;
(b) My personal referees and employer/s
(c) Any record listing or database of defaults by tenants such as NDT, TICA or TRA
Pension no. (if applicable) Pension type (if applicable) for the purpose of checking your tenancy history;
I am aware that I may access my personal information by contacting;
NTD: 1300 563 826
TICA: 1902 220 346
TRA: (02) 9363 9244
6. Please provide your contact details If I default under the rental agreement, I agree that the Agent may disclose details of any
such default to a tenancy default database, and to agents/landlords of properties I may
Home phone no. Mobile phone no. 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
(b) prepare lease/tenancy documents
Work phone no. Fax no. (c) allow tradespeople or equivalent organisations to contact me
(d) lodge/claim/transfer to/from a Bond Authority
(e) refer to Tribunals/Courts & Statutory Authorities (where applicable)
(f) refer to collection agents/lawyers (where applicable)
(g) complete a credit check with NTD (National Tenancies Database)
Email address
I am aware that if the 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.
7. What is your current address?

Signature of The Applicant Date

Postcode X / /
F. APPLICANT HISTORY H. CONTACTS / REFERENCES
8. How long have you lived at your current address? 16. Please provide a contact in case of emergency
Surname Given name/s
Years Months

9. Why are you leaving this address?

Relationship to you Phone no.

10. Landlord/Agent details of this property (if applicable)

Name of landlord or agent 17. Please provide 2 personal references (not related to you)
1. Surname Given name/s

Landlord/agent’s phone no. Weekly Rent

Relationship to you Phone no.
$

11. What was your previous residential address?

2. Surname Given name/s

Postcode
Relationship to you Phone no.
12. How long did you live at this address?

Years Months
I. OTHER INFORMATION
13. Landlord/Agent details of this property (if applicable)
18. Car Registration
Name of landlord or agent

19. Please provide details of any pets

Landlord/agent’s phone no. Weekly Rent Breed/type Council registration / number
$ 1.

Was bond refunded in full? If not why not? 2.

PLEASE NOTE
Initial payments must be made by cash, bank cheque or money order
G. EMPLOYMENT HISTORY within 24 hours after approval of application. No Personal Cheques
14. Please provide your employment details accepted.
What is your occupation?
Keys will not be handed over until the lease agreement has been
signed by all applicants.

What is the nature of your employment? This application is accepted subject to the availability of the property on
the due date and no action shall be taken by the applicant against the
Full Time Part Time Casual Unemployed landlord and the agent should any circumstances arise whereby the
Employer’s name (inc. accountant if self employed or institution if student) property is not available for occupation on the due date.

HOW DID YOU FIND OUT ABOUT THIS PROPERTY?

Employer’s address The Age The Internet Local Paper
Board Counter List Relocation Company
Referral Other (specify)
Postcode
PLEASE PROVIDE US WITH 100 POINTS OF IDENTIFICATION
Contact name Phone no. Driver’s Licence 50

Passport 50
Length of employment Net Income Proof of Age Card 50
Years Months $
Student ID Card 50
15. Please provide your previous employment details Copy of Mobile Phone Account 20
Occupation?
Copy of Medicare Card 20

Concession / Pension Card 10

Employer’s name
Copy of Gas/Electricity account 30 each

OFFICE USE ONLY

Length of employment Net Income Property Rental
Years Months $ $ per week $ per month

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