Bond lodgement form Tenancy

› All sections of this form must be completed to enable smooth processing of information, payment and future refunds
› Landlords’ and all tenants’ signatures must be provided. Incomplete forms will be returned
› Complete in a black or blue pen with CAPITAL letters if handwriting
› Read the important information on the back of this form before entering any details

1 If payment is to an existing bond for this tenancy, enter the bond number here:

2 Address of the rented property Property ID (if known):

Room no.
(for boarding house
or room only tenancy) Unit 4 House no. 126 Street Marua Road
Suburb Ellerslie City Auckland
Building name Postcode 1051
Weekly rent 690.00 Total bond 2,760.00 Total amount enclosed 2,760.00
Date tenancy started No. of Dwelling type (tick one): House/Townhouse ✔ Apartment Room
2
1 D
D 4 M0 M6 2Y 3Y bedrooms See reverse for definitions
Boarding house room Bedsit/Flat

3a Landlord details Are you a first time landlord? Yes Landlord ID: 2 1 7 6 3 2 3
Full name(s) or trading name Barfoot & Thompson Mt Roskill
Contact phone 096210917
3b Landlord address for service Email will be first point of contact if provided

Email mtroskill.rental@barfoot.co.nz Landlord Signatures

Unit House no. 1005 Street Dominion Road

Suburb Mt Roskill City Auckland
PO Box or By signing this form you agree that the Date D D M M Y Y
Private Bag Postcode 1041 infor­mation you have provided is true and correct

4a Tenant 1 details
Full name Jibeesh Rajan Bond contribution 2,760.00
Date of Birth D D M M Y Y 021 673 436
Are you a first time tenant? Yes (optional) Contact phone

4b Tenant 1 new address for service Email will be first point of contact if provided

Email jibeesh.off@gmail.com Signature

Room no.
(for boarding house
or room only tenancy) Unit 4 House no. 126
Street Marua Road
Suburb Ellerslie City Auckland
PO Box or By signing this form you agree that the Date D D M M Y Y
Private Bag Postcode 1051 information you have provided is true and correct

4c Tenant 2 details
Full name Bond contribution
Date of Birth D D M M Y Y
Are you a first time tenant? Yes (optional) Contact phone

4d Tenant 2 new address for service Email will be first point of contact if provided

Email Signature

(for boarding house

Room no. or room only tenancy) Unit House no.

Street

Suburb City
PO Box or By signing this form you agree that the Date D D M M Y Y
Private Bag Postcode information you have provided is true and correct

Use the Additional tenants bond lodgement form if more than

2 tenants. Attach it to this form. Yes, this form is attached.
 Tenancy

If you need to add more tenants, please use the Additional tenants bond lodgement
form and attach it to this form.

Privacy statement Bedsit/Flat: When you live in a place In addition to a street address,
Personal Information provided on which is either part of a subdivided a PO Box can also be provided to
this form will be held and used by building, or a building which is be used as an address for service.
the Ministry of Business, Innovation independent of the primary residence PLEASE NOTE: By providing a PO Box
and Employment for the purposes of a property (e.g. sleep-out) or email address, you are authorising
of administering and enforcing Tenancy Services to use these to
the Residential Tenancies Act 1986. Property ID number contact you.
It may also be used for carrying out If you do not know the Property
customer surveys, public education ID number for this property, leave Any questions?
and statistical analysis, and we may the box blank. All our forms and other information
occasionally provide your information
are on our website at
to third parties to carry out this work Weekly rent and Dwelling type www.tenancy.govt.nz
on our behalf.
This information is gathered by If you have any questions about
We collect date of birth information Tenancy Services so that the general this form or need more information
to help us correctly identify you. public and landlords have access to about bonds, please Freephone
Supplying your date of birth current rental market information 0800 737 666 or contact us by email
is optional. through the Tenancy Services at www.tenancy.govt.nz/contact-us
Bond contribution information website. No personal, individual
bond or property information will Ki te mea he pātai āu mō tēnei puka,
provided to Tenancy Services may
be published there. kei te pīrangi pārongo rānei mō te
be used to help confirm refund
moni here (bond), waea koreutu
details for each tenant at the end No. of bedrooms – If you are only 0800 737 666, whakapā rānei ki a
of the tenancy. Supplying this renting a room, the number of
information is optional. mātou i te īmēra www.tenancy.govt.
bedrooms is one. nz/contact-us
The personal information you supply
Landlord ID number ’A iai ni fesili e uiga i lenei pepa pe
will not be used for any other reasons
mana’omia fo’i nisi fa’amatalaga
unless permitted under the Privacy If you do not know the Landlord ID e uiga i le tupe fa’amau (bond),
Act 2020 (e.g. with your consent number, leave the box blank. fa’amolemole telefoni mai i le numera
or for a directly related purpose).
0800 737 666, pe feso’ota’i mai ile
The information may also be provided Address for service
to third parties where it is required emeli www.tenancy.govt.nz/
This information will assist Tenancy contact-us
or permitted by law. The personal
information you supply will be Services to contact you regarding this 若您有任何关于本表格方面的疑问, 或是
provided to all parties named on this bond and to minimise any delays in 希望获得 有关押金的更多详情, 请拨打我
form or on the bond record. You can paying out/refunding the bond when 们的免费热线电话 0800 737 666, 或发
access or correct your personal the tenancy finishes. 送电邮至以下网站内的相应电邮 地址,
information held by us at any time. Landlord’s address for service: 与我们联系: www.tenancy.govt.nz/
If you provide an email address, we contact-us
Dwelling type definitions will use this as the primary means for If you have questions about your
House/Townhouse: When you live communication. However, a physical rights and obligations when renting
in a self-contained property, usually address must also be provided. call our tenancy information line
a building with land If we need to contact you at a street Freephone: 0800 TENANCY
address regarding this tenancy we (0800 83 62 62)
Apartment: When you live in a
property with self-contained areas will use the address for service you
(e.g. apartments, units) and shared provided. How to send us your form(s)
areas (e.g. building lifts, driveways) In addition to a street address, Online: If paying online, please go to
a PO Box address can also be www.tenancy.govt.nz and follow the
Boarding House Room: When you
provided as an address for service. ‘Lodging a bond online’ instructions.
live in a room in a boarding house
– i.e. rented separately but sharing Tenant’s address for service:
facilities in a building intended for If you provide an email address, we Tenancy Services
6 people or more will use this as the primary means for PO Box 50 445
Room: When you live in a room in a communication. If we need to contact Porirua 5240
house which is not a boarding house you at a street address during your
– i.e. rented separately but sharing tenancy we will use the address of
facilities in a building intended for the rented property or the address
less than 6 people for service you give us. A new address
for service is required after the
tenancy has ended.

MBIE 6204 T1 (11/20)