APPLICANT NAME*
Date of birth*
Phone Home*
Phone Mobile*
Phone Work*
Email Address*
Current Address
Details*
PREVIOUS RENTAL HISTORY
Address
Rent paid per week $
Property manager or lessor’s name
Phone
Property manager or lessors address
Date Rented from
Date Rented to
Reasons for leaving
REFERENCES - PERSONAL
01 Reference Name
Relationship to applicant
Contact phone
02 Reference Name
EMPLOYMENT DETAILS (if self-employed less than one year, give previous employer)
Occupation
Employer
Employer’s address
Employed from
Employed to
Net income $ per week
Net weekly income from other sources $ per week
EMERGENCY CONTACT
Name
How related
Phone Home
Phone Work
Phone Mobile
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