Residential Tenancy Application Form

Select a Premium Property Manager

Property Details

Address of property Preferred tenancy commencement date (e.g. 27 January 2018)
Weekly rent ($) Preferred length of tenancy (months)

Tenant Details

First name Middle name Surname Phone Mobile
Driver license number Driver license version (5b) Date of birth Email

Contacts and References

By supplying references, you agree to allow us to contact them.

Referee 1: full name Referee 1: phone Referee 1: relationship
Referee 2: full name Referee 2: phone Referee 2: relationship


WINZ no.
Income per week ($)

Employment Details

Current Employer Phone Income per week ($) Contact person
Time with employer (years and months) Address of employer

Current Address and Landlord / Property Manager Referee

Address Time at address (years and months) Reason for leaving
Landlord name Landlord phone

Previous Address and Landlord/Property Manager referee (if less than 2 years at current address)

Address Time at address (years and months) Reason for leaving
Landlord name Landlord phone

Applicant Requirements

Garaging Number of cars Number of bedrooms
Number of adults Number of children Fencing:

Applicant History

Have you ever had a tenancy terminated before?

If yes, provide details: Have you ever had money deducted from your bond?

If yes, provide details:
How much do you owe finance companies ($)? How much do you owe a landlord/PM ($)?

Motor Vehicles

If you will be parking a motor vehicle on the property, indicate how many:

Registered owner Make Model Colour Registration Finance company
Registered owner Make Model Colour Registration Finance company


Do you have pets?

If yes, provide details:

Premium Executive Rentals are an independently owned and operated business. We are bound by the Privacy Act 1993. We collect personal information about you in this form to assess your application for a Residential Tenancy. We may need to collect information about you from your previous landlords or letting agents, your current employer, credit agencies and your referees. Your consent to us collecting this information is set out below. We may disclose personal information about you to the owner of the property to which this application relates and any third party company as outlined below. If this application is successful we may disclose your contact details to maintenance contractors and the landlord’s insurers. We may also send personal information about you to the owners of any other properties at your request. You have the right to access personal information that we hold about you by contacting our office. If you do not complete this form or do not sign the consent below then your application for a residential tenancy may not be considered by the owner of the relevant property or, if considered, may be rejected.

I agree to the collection, use and disclosure of my personal information for the following purposes:
  • Checking any details contained in this application form with third parties including Tenant Information Database and the New Zealand Transport Authority
  • Making enquiries with third parties in relation to my creditworthiness, including any credit reporting agency
  • Placing any of the information regarding my identity supplied in this application form on a national online database
  • Using any of the information contained on any Tenancy Tribunal Order to assist the enforcement of any unsatisfied Money Order made against me by listing details of the order on an online national database
  • Using any of the information on this application form to assist in the enforcement of any unsatisfied Order made against me by the Tenancy Tribunal
  • Debt recovery purposes including appointing an agent to collect outstanding debts and listing defaults with any credit reporting agency
  • Checking the Ministry of Justice fines database. This may be undertaken by a credit reporting agency on our behalf which will require my personal information to be collected by and disclosed to the credit reporting agency
I understand that any credit reporting agency to whom you may disclose my personal information may:
  • Hold that information on their credit reporting database
  • Use that information for the purpose of credit reporting or for any other lawful purpose
  • Disclose that information to their subscribers for the purpose of credit checking or debt collection or for any other lawful purpose
I understand that if I have provided to you Driver Licence information that the provision of this information was voluntary.
I confirm the information in this form is true and correct and that I have read and signed the Cautions under the Privacy Act 1993.
I agree that if I enter a Tenancy Agreement then this application will form part of the Tenancy Agreement.
Cautions provided pursuant to the Privacy Act 1993 and other information before applying for a Residential Tenancy.

In Terms of the Privacy Act 1993 you are given notice that:
  • Requests Information – this application form asks you to provide personal information; and
  • Purpose of Collection – the information collected on this form is required so that the Landlord is better able to assess whether you would be the best applicant on merit for the Tenancy and to record limited information contained in the application form on a web-based database. The limited information concerns your identity and last known address. This information is required to assist the Landlord in locating you to enforce any unsatisfied money order made by the Tenancy Tribunal; and
  • Recipient of Information – the information is provided by you to the Owner/Landlord/Agent/Property Manager; and
  • Sight Information – I/We advise you that you have the right to see the information I/We hold about you; and
  • Correct Information – to correct that information if it is incorrect in accordance with the Privacy Act 1993; and
  • Holding information – if you do not enter a Tenancy Agreement with the Landlord referred to on this application form, the application form will be destroyed; and
  • Uses of Information – you are advised that some information relating to your identity and last known address may be supplied to a national web based database; and
  • Agree to pay letting fee on entering the premises.

Supporting Documentation — all required

A copy of your identification such as Drivers Licence or Passport (.jpg only)

A copy of your last payslip or GST Return (if self employed) (.jpg only)

A copy of your second-to-last payslip or GST Return (.jpg only)


By completing this form you evidence the fact that you are applying to rent a Residential Property, and – you undertake that if you are accepted for this property you will be required to pay 4 weeks bond, one weeks letting fee (plus GST) and at least one weeks rent prior to being given the keys. Please NOTE: We are not obliged to accept Bond Transfers

I, do solemnly and sincerely declare that I am over 18 years of age and affirm the information given in this form to be true and correct.

Please type today's date (17 July 2018):