PROPERTY APPLYING FOR

• Property Address: Rent per week $
• Move in Date: Length of tenancy
• How did you hear about Executive Property Management?

APPLICANTS PERSONAL DETAILS

• Full Name(s) *
• Current Address *
• Mobile * Work Phone
• Home Phone Fax
• Email*
• Date of Birth * WINZ No
• Drivers Licence No Version (5b on card)
• Car Make & Model Car Registration

NAMES OF OTHER INTENDED OCCUPANTS (Including Children)

• 1. Name Relationship Phone
• Name to Lease 
• 2. Name Relationship Phone
• Name to Lease 
• 3. Name Relationship Phone
• Name to Lease 
• 4. Name Relationship Phone
• Name to Lease 
• 5. Name Relationship Phone
• Name to Lease 

EMERGENCY CONTACT DETAILS (Usually a mother, brother, sister or guardian)

• Full Name(s) * Relationship
• Address* Mobile Phone
• Email* Work Phone

NEXT OF KIN (Close family member)

• Full Name(s) * Relationship
• Address* Mobile Phone
• Email* Work Phone

REFEREES

• 1st Referee Name * Relationship
• Email * Mobile Phone
• 2nd Referee Name* Relationship
• Email * Mobile Phone

CURRENT ADDRESS

• Current Address Rent Paid
• Length of Time at Current Address Reason for Leaving
• Name of Landlord/ Property Manger Mobile Phone

PREVIOUS RENTAL HISTORY (If less than 3 years at current address)

• Previous Address Rent Paid
• Length of Time at Current Address
• Name of Landlord/ Property Manger Mobile Phone

CURRENT EMPLOYMENT (Please select one)

• What is your source of income?  Current Employment Self Employment WINZ Study

PLEASE ANSWER THE FOLLOWING (Please tick where appropriate)

• Have any of your previous tenancies been terminated? Yes  No 
• Are you in debt to another Landlord/ Property Manager? Yes  No 
• Do you or any other intended occupants smoke? Yes  No 
• Do you have any pets? Yes  No 
• Is there any reason that may affect your rent payment? Yes  No 
• Do you have a criminal conviction? Yes  No 

• Verification Code:
  
  Type the characters you see above
  
• * Denotes required before submitting