Rental Property Management, New Plymouth, Taranaki

A separate form is required for each person (except for family members).
* Required Fields

PROPERTY INFORMATION
This information is provided by you to ENERGY CITY REALTY LTD for the purposes of assessing your eligibility as a tenant for:
Address:
PERSONAL INFORMATION
Full Name:	* Name is required.
Date of Birth:	* DOB required.Invalid format - dd/mm/yyyy.
Present Address:
Phone:	* Phone number is required.


Email:	* Email required.Invalid format.
Number of Dependants:
	Names of Dependants
Current Employer:
Length of Service:
Motor Vehicle(s) Make:
Registration Number(s):
NEXT OF KIN INFORMATION
Next of Kin Name:
Next of Kin Address:
Next of Kin Phone:
Pet	None Cat Dog Others
CURRENT / PREVIOUS LANDLORD INFORMATION
Current Landlord Name:
Current Landlord Address:
Current Landlord Phone:
1. Prior Landlord Name:
1. Prior Landlord Address:
1. Prior Landlord Phone:
2. Prior Landlord Name:
2. Prior Landlord Address:
2. Prior Landlord Phone:

Additional Comments / Information you wish to provide us with:

Required. Yes I agree to the following: IMPORTANT I consent to you providing the information in this form and details of any breach of my tenancy agreement or of the Residential Tenancy Act 1986 to any credit bureaux or tenant default database. I acknowledge that the information may then be publicly accessible through credit bureaux or tenant default databases. I agree that you may use any of the information on this form to enforce any judgement in respect of the tenancy agreement or in respect of any order against me made by the Tenancy Tribunal. I consent to you contacting any tenant default database, credit bureau and/or any of the mentioned referees. I confirm the information in this form is true and correct and that I have read the Privacy Act statement.