To print this form to post or fax back to us click here to download it in PDF format. First Name (required) Middle Name Last Name (required) Email (required) Work Phone Number Mobile Phone Number Current Address (required) Date of Birth (dd/mm/yy) (required) Applying For What address is this application for? How Long Have You Lived at Current Address? Why Are You Leaving? Number of Bedrooms Required? 1 Bedroom2 Bedrooms3 Bedrooms4 Bedrooms Maximum Rent ($) Number of People Intending to Reside There Adults Children Total Number of People Intending to Reside there? Preferred Areas Do you Need to Give Three Weeks Notice?YesNo Latest Date Property Required? (dd/mm/yy) Personal Info Occupation Current Employer Address of Employer Phone Number of Employer Motor Vehicle Make Motor Vehicle Model Motor Vehicle Registration Number Do You Have a Pet? YesNo If Yes, What is the Pet? Next of Kin? Relationship of Kin to You Address of Next of Kin Phone Number of Next of Kin Applicants Identification WINZ Number Driver's License Number Landlord References I AGREE to You Contacting Any of these Referees YesNo Landlord Reference Name 1 Landlord Reference Phone 1 Landlord Reference Name 2 Landlord Reference Phone 2 Consent I consent to Jim Brown Rentals making such enquiries, as they feel necessary to process this application, which may include a credit check. This application is kept for one month only unless we have further contact with you I Consent to Jim Brown Rentals to Make Enquiries Yes Code verification, please insert this code in the field bellow
