Grassam Real Estate

The Best Move You Can Make

I confirm the following:

I acknowledge that this is an application to rent this property and that my application is subjected to the Landlords approval.

1/ This information is required to assess whether you are a minor and able to enter this contract without approval of the tenancy Tribunal.

2/ You are entitled to access and correction of this information

3/ If you fail to provide any of the information you may not be selected as the best applicant for the Tenancy.

4/ I declare that the information given is correct and true and that the Landlord/Property Manager may check on any of the details given.

5/ I agree to any of this information being given to another Landlord.

6/ I agree that the Landlord can obtain other information about me.

7/ I agree that the Landlord may use any of the information on this to enforce any judgment or money order obtained against me.

8/ I authorize the Landlord to obtain information from Baynet, and Postal Authority, Power Supply Company, Gas Company, Telecommunication Company, WINZ and or your employer (present and past).

9/ I declare that this authority cannot be subsequently cancelled by me, during the term of this tenancy or any other matters subsequently arising as a result of this tenancy

THE APPLICATION consents Grassam Real Estate Ltd should it so desire, obtaining written or verbal references from any nominated referees.

Registration is a free process. The applicant further understands that a bond of 2 or 3 weeks’ will be required in accordance with Residential Tenancies 1986 and amendments.

I, the person named on the “registration and Tenancy Application” on the reverse declare that the above information about the rights under the Privacy Act 1993 was brought to my attention before I completed the Registration and Tenancy Application From.

Applicant Surname

First Name

Address of Property (Registering for)

Home Phone

Work Phone

Mobile Phone




Date of Birth

Car Reg

Drivers License


Property Applied For

Any Pets? Please Specify

Preferred Length of Tenancy

Preferred Commencement Date of Tenancy

Total No. of Occupants To Reside In Premises

Your Next of Kin


Contact Number

Address for Service

Present Address

Date Moved In

Present Landlord


Reason for Moving

Previous Address

Previous Landlord

Rental Payment Preference

TWO Character References – (NO FAMILY MEMBERS PLEASE)





Names of Others to Occupy the Premises:











What is ?