Additional Occupant Form

Applicant Details

Property applied for *

Please enter the street address of the property you are applying for

Applicant details

Full name *

Email Address *

Date of birth

Home phone

Mobile phone

Work phone

Are you a smoker?

Yes

Do you have pets?

Yes

If YES, please provide details

How many vehicles will you be parking at the new tenancy?

None

Do you have a firearms licence?

Yes

If YES, please upload a photo or scan of your firearms license

Do you own or have any firearms in your possession?

Yes

If YES, please list all details of each firearm

Do you have a criminal conviction or a possible criminal conviction pending?

Yes

If Yes, provide details

Have you been known by any other names?

Yes

If Yes, provide details

What is your current address?

How long have you lived at your current address?

Identification

Drivers license number

Version (5b)

File Upload

Please upload a scan or photo of your drivers license or identification

Employment Details

Are you currently employed?

Yes

Work and Income New Zealand customer number?

Please provide details for your current employer, if you are currently unemployed please provide details for previous employer.

Name of employer

Address of employer

Employers Phone Number

Name of Contact Person

Occupation

How much is your weekly after tax income? (take home pay)

Length of employment

Current/Most Recent Tenancy Details

Are you renting currently?

Yes

How long have you lived at your most recent tenancy?

Address of most recent Tenancy? (if different from your current address)

Landlord or property manager name *

Landlord or property manager address

Phone number *

Email address

Have you ever had a tenancy terminated? *

Yes

If YES please provide details

Have you ever had money deducted from your bond?

Yes

If YES please provide details

Are you currently paying off debt to a property manager/landlord?

Yes

If YES please provide details

Is or was your rent paid up to date on your recent tenancy?

Yes

How much were you paying in rent each week?

Reason for leaving your most recent tenancy?

Do you expect to have the bond repaid in full?

Yes

Previous tenancy

What was the address of your previous tenancy?

How long did you stay at your previous tenancy?

Address

Previous Landlord or property manager name

Previous Landlord or property manager address

Previous Landlord or property manager phone number

Previous Landlord or property manager email address

Character Reference (not a friend or family member

Name

Phone number

Next of kin (used for address for service)

Name

Address

Phone number

Relationship

Privacy Act Waiver *

Applicant Consents

I agree to authorise Bolitho Property Management Ltd to use the details given here to obtain references as necessary.

I agree to the collection, use and disclosure of my personal information for the following purposes, and warrant that I have supplied all information on this form freely, including my drivers license details and passport details. I agree that any information found through any third party databases that relates to me can also be used for the purposes outlined in this application.

Recipient of information

The information is provided by you to the Owner/ Landlord/Agent/ Property Manager.

Purpose

The purpose for the collection of my information is:

To perform background checks, reference checks and credit checks to assess if I am the best applicant on merit. I consent that my personal information including debts may be discussed with any personal or work referees

To add my information to any background, reference and credit checking database To allow the Landlord to add a review to a tenancy review database that can then be viewed by other companies and/ or Landlords To check the Ministry of Justice fines, Tenancy Tribunal, District Court, High Court, Court of Appeal, Supreme Court, Department of Parole, and New Zealand Police databases

For debt collection purposes

To check the Personal Properties Securities Register

To verify my passport details via the Department of Internal Affairs

To check and update a credit bureau

To update the Tenant check system.

Information Provided

The information provided on this form and any information found through the background check, reference check and credit checking process may be passed onto an agent and entered into third party databases, inclusive of any credit reporting databases. Subscribers to the databases will have access to my information and use that information for the purpose of credit reporting or for any other lawful purpose including debt collection.

I agree that I have been advised that I have the right to see the information that you hold about me, and to have any information held corrected if it is in error.

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.

I accept the Privacy Act Waiver