Below is our online Rental Application form. Please fill out your Application in full in order to submit it. "*" indicates required fields PART 1: Rental Property DetailsAgent Details Helen Harm Real Estate 53 Fitzroy Street, PO Box 859 Warwick QLD 4370 Phone: (07) 4661 3663 Mobile: 0408 457 496 Email: helen@helenharm.com Property DetailsAddress* Street Address City State / Province / Region ZIP / Postal Code Rent*Rent Period*WeeklyFortnightlyMonthlyBond*Tenancy Term* Fixed Term Agreement Yes Periodic Agreement Yes Starting On* Ending On* PART 2: Applicant DetailsContact DetailsName First Last Date of Birth MM slash DD slash YYYY Are you applying with anyone else?* Yes No What is their full name?* First Last Have you been known by any other name(s)?* Yes No Yes No If Yes, what other name(s) have you been known by?* Work Phone*Home Phone*Mobile Phone*Email* Driver's Licence/Passport Number* State* Number Of Vehicles* Registration Number(s)* DependantsDo you have any dependants?* Yes No Dependant Full Name(s)*Relationship To Applicant*Dependant Date Of Birth*SmokingAre you or any of the dependants living with you a smoker?* Yes No PetsDo you intend to keep pets at the property?* Yes No Number Of Pets*Type Of Pet/s* Breed of Pet/s* Are your pets registered with a council?* Yes No If Yes, please state which council* Initials* Applicants Address HistoryCurrent Residential Address* Street Address City State / Province / Region ZIP / Postal Code Period Of Occupancy* Type Of Occupancy* Rental Owner Other Current Agent/Lessor (if renting)* Agent/Lessor Phone*Agent/Lessor Email* Current Rent*Rent Period*WeeklyFortnightlyMonthlyReason For Leaving* Previous Residential Address* Street Address City State / Province / Region ZIP / Postal Code Period Of Occupancy* Type Of Occupancy* Rental Owner Other Previous Agent/Lessor (if renting)* Agent/Lessor Phone*Agent/Lessor Email* Previous Rent*Rent Period*WeeklyFortnightlyMonthlyReason For Leaving* Employment DetailsAre you Employed?* Yes No If no, please provide details of previous employer if any.Employment Status* Full Time Part Time Casual Contract Self Employed Occupation* Net Income (per week)*Date Commenced Employment (approx)* Date Terminated Employment (if any) Employer/Business Name* Employer/Business Address Street Address City State / Province / Region ZIP / Postal Code Employer/Business Phone*Employer/Business Email* If Self Employed, Accountant's Name* Accountant's Phone*Centrelink PaymentsAre you receiving any regular Centrelink payments?* Yes No Description of payment(s)* Date Payments Commenced* Are you an overseas student?* Yes No Visa expiry date* Initials* Personal ReferencesPlease do not list relatives, another applicant or partners and provide business hours contact numbers.Referee 1* Relationship* Phone/Mobile*Referee 1 Address Street Address City State / Province / Region ZIP / Postal Code Referee 2* Relationship* Phone/Mobile*Referee 2 Address Street Address City State / Province / Region ZIP / Postal Code Personal Representativei.e preferred person(s) to be contacted in the event of an emergency.Representative 1* Relationship* Phone/Mobile*Representative 1 Address Street Address City State / Province / Region ZIP / Postal Code Representative 2* Relationship* Phone/Mobile*Representative 2 Address Street Address City State / Province / Region ZIP / Postal Code PART 3: Supporting Documents100 points of ID documents. (E.g. driver’s license, payslips.) If these documents are not received we can not process your application.70 Points Passport Full Birth Certificate Citizen Certificate 40 Points Australian Driver's Licence Centrelink Card Student Photo ID Proof Of Age Card Department Of Veterans Affairs Card State /Federal Government Photo ID 25 Points Medicare Card Council Rates Notice Motor Vehicle Registration Telephone Bill Electricity Bill Gas Bill Tenancy History Ledger Bank Statement Credit Card Statement Last FOUR Rent Receipts Rent Bond Receipt Previous Tenancy Agreement Proof Of Income You are also required to supply the Agent/Lessor with proof of your income upon submission of your application. Employed: Last TWO pay slips. Self employed: Bank statements, Group Certificate, Tax Return or Accountant's letter. Not employed: Centrelink statement.Part 3.5: Supporting DocumentIdentification You are required to meet a 100 point identification criterion upon submission of your application. The Agent/Lessor may photocopy any item and retain as part of your application. Please tick the identifying documents you have provided with your application. IMPORTANT: At least one form of Photo identification MUST be provided. If these documents are not received we can not process your application.File Upload* Drop files here or Select files Max. file size: 128 MB. Initials* PART 4: DeclarationPlease declare the following by selecting either yes or no I, the Applicant, 1. Have never been evicted by an Agent/Lessor* True False 2. Have no known reason that would affect my ability to pay rent* True False 3. Was refunded the rental bond for my last address in full (if applicable)* True False If false, please advise what deductions were made from your bond? 4. Have no outstanding debt to another Agent/Lessor?* True False If false, why are you in debt to your past Agent/Lessor? PART 5: Tenancy DatabasesThe Agency may use the following tenancy database to check the rental history of the applicant/s: TICA, Police History Check, ID Verification Check.PART 6: AcknowledgementPlease declare the following by selecting either true or false I, the Applicant, 1. Acknowledge that my personal contents insurance is not covered under any Lessor insurance policy/s and understand that it is my responsibility to insure my own personal belongings.* Yes No 2. Understand that you as the Agent/Lessor have collected this information for the purpose of determining whether I am a suitable tenant for the proper - in particular to check my identification, my ability to care for property, my character and my creditworthiness.* Yes No 2.1 For such purposes, I authorise you to contact the persons named in this application, and to undertake such enquirers and searches (including tenancy databases searches) as you consider reasonably necessary.* Yes No 2.2 In doing so, I understand that information provided by me may be disclosed to, and further information obtained from, referees named in this application and other relevant third parties.* Yes No 3. Acknowledge and accept that if this application is denied, the Agent is not legally obliged to provide reason as to why.* Yes No 4. Consent and understand that should my tenancy be accepted and upon commencement of the tenancy agreement, there may be cause for the Agent/Lessor to pass my details onto others which may include (but is not limited to) insurance companies, body corporate, contractors, other real estate agents, salespeople and tenancy default databases.* Yes No 5. Acknowledge that I have received and reviewed the General Tenancy Agreement (form 18a) and Standard Terms and any special terms before completing this application.* Yes No 6. Acknowledge that i have received or have available the Information Statement (Form 17a), body corporate by-laws (if applicable) before completing this application.* Yes No 7. Acknowledge that I have signed the agency's Privacy Notice and Consent.* Yes No 8. Acknowledge that the Lessor and Applicant (tenant) are bound by this agreement immediately upon communication of either the lessor or agent's acceptance of the application.* Yes No 9. Consent to the use of email and facsimile in accordance with the provisions set out in Chapter 2 of the Electronic Transaction (Queensland) Act 2001 (QLD) and the Electronic Transactions Act 1999 (Cth)* Yes No 10. Declare that the above information is true & correct and that I have supplied it of my own free will.* Yes No Name of Applicant* Date MM slash DD slash YYYY Please upload a photo of your signature.*Max. file size: 128 MB. Δ
