Complete our Online application form by filling in your details and clicking the submit button below. Please note the online application is conditional on providing satisfactory Photo ID at our office prior to tenancy.

PROPERTY DETAILS YOU WANT TO RENT (* required)
Property Street address *
Suburb/Town *
Postcode *

Lease Commencement Date? *		Click to enter date
Lease terms (months)
Rent (months)

Number of occupants *		Adults
		Children

PERSONAL DETAILS

Title	Choose Mr Ms Miss Mrs Other
First name *
Last name *
Date of birth	31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 09 08 07 06 05 04 03 02 01 Day Month Jan Feb March April May June July Aug Sept Oct Nov Dec Year 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900
Contact number - BH *
Contact number - AH *
Mobile number
Facsimile
Email *

Pets *

Yes

No

If yes, what breed or type?
Council Registration number?

IDENTIFICATION

Current drivers licence or passport number *
State of licence or country of passport *
ABN/ACN number if self-employed

APPLICANT HISTORY

Current address *
How long have you lived at your current address? *
Why are you leaving this address? *

Landlord/Agent details*
Contact number - BH *
Mobile number

Length of stay (months)*

Rent - monthly *

Is your rent paid up to date?

Yes

No

PREVIOUS LANDLORD/AGENT

Previous address
Landlord/Agent
Contact number - BH
Mobile number

Length of stay (months)

Rent - monthly

Was bond refunded in full? If not why not?

EMPLOYMENT HISTORY

Current employer
Contact
Contact number
Mobile number
Employers address
Suburb/Town
Postcode

Length of employment

Income

PREVIOUS OCCUPATION (if employed at your current job for less than two years)

Previous employer
Contact
Contact number
Mobile number
Employers address
Suburb/Town
Postcode

Employment period

Income

PROFESSIONAL REFERENCES

Reference 1
Name
Address
Contact number

Reference 2
Name
Address
Contact number

EMERGENCY INFORMATION

Next of kin *
Relationship *
Address *
Contact number *

SEND APPLICATION

I accept that Kerleys Coastal Real Estate Pty Ltd may conduct independant reference and credit checks on this application.

Confirmation

Please Tick to agree to Terms and Conditions contained in the Declaration.

DECLARATION

By sending this form to Kerleys Coastal Real Estate 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 Tenancies Agreement pursuant to the Residential Tenancies Act 1997.

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 landlord and the agent should any circumstances arise whereby the property is not available for occupation on the due date.

I acknowledge that this application is subject to the approval of the owner/landlord. I declare that all information contained in this application is true and correct and given of my own free will. I declare that I have inspected the premises and am not bankrupt.

I authorise the Agent to obtain personal information from:
(a) the owner or the Agent of my current or previous residence;
(b) my personal referees and employer/s;
(c) any record, listing or database of defaults by tenants;
If I default under a rental agreement, the Agent may disclose details of any such default to a tenancy default database, and to agents/landlords of properties I may 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
(c) allow organizations/trades people to contact me
(d) lodge/claim/transfer to/from the Residential Tenancies 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)
(h) transfer water account details into my name

I am aware that if 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. I am aware that I may access personal information on the contact details above.

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