Please fully complete all sides of this form for you application to be processed. Please complete one application per person.
1. Property Details, that you are applying for
2. If self-employed, please complete the following
3. Personal Details
Where did you see this property advertised?New Address
Suburb  Post Code
Lease Term Years Months
Preferred commencement date          /          /              to          /          /Rent Payable for Property  $ per week Lease to be in Name(s) of:(All adults to reside at the property must be listed)
Is this to be your principal place of residence (please tick) Yes No Do you plan to operate any part of your business from home(please tick)  Yes
No
NB: All properties leased through Domain Property Advocates have a no smoking policy inside the premises.
Company Name Company Address Suburb  Post Code
Business Type Position Held A.B.N.
Accountant Name and Phone Solicitor Name and Phone
Title
First Name
Middle Name Last Name Date of Birth              /              /                Current Address Suburb
Post Code
Identification (attach copy)
Drivers Licence Number State of Issue
Drivers Licence Expiry Date
Alternate ID (eg passport) No. Country issued
Pension Type No.
Home Phone Number Mobile Phone Number
Work Phone Number Email Occupation Employers Name
If student, include institution.Course name Contact Name Phone
Enrolement number
(photocopy of student card must be attached)
86 Denmark Street KEW VIC 3101  |  P: 03 9853 5599  |  F: 03 9853 5522
info@domainadvocates.au  |  www.domainadvocates.au
domain web
11/ 246    buffalo  road
truncated formclose to the top Rede shoping centre yes 1282013782014300sean
Mr.
Wang
hua xiang
40millwood AVE Chatswood West,NSW
2067
123@hotmail
seanwong
4. Utility Connection Service
5. Current Residence Information
This is a free service that connects all your utilities
Once we have received this application we will call you to confirm your details.
Direct Connect will make all reasonable efforts to contact you within 24 hours of the nearest working day on receipt of this Application to confirm the information on this Application and explain the details of the services.  Should you not be contacted please contact your Property Manager directly at least 48 hours prior to moving in to ensure power is connected for you.
Please tick utilities as required
Electricity Gas Water Insurance Phone Internet Pay TV
DECLARATION AND EXECUTION: By signing this application, I/we: consent to Direct Connect arranging for the connection and disconnection of the nominated utility services and to providing information contained in this application to utility providers for this purpose; acknowledge having been provided with terms and Conditions of Supply of Direct Connect and having read and understood them together with the Privacy Collection Notice set out below; declare that all the information contained in this application is true and correct and given of their own free will;
expressly authorise Direct Connect to provide any information disclosed in this Application to a supplier or potential supplier of the Services in accordance with the Privacy Collection Notice and to obtain any information necessary in relation to the Services; expressly authorise Direct Connect to provide any information disclosed in this Application to an information provider for the purpose of that information provider disclosing it to a supplier or potential supplier of the Services in accordance with the Privacy Collection Notice and to obtain any information necessary in relation to the Services; consent to Direct Connect contacting me by telephone or by SMS in relation to the marketing or promotion of all of the services listed under the heading “Utility Connections” above even if we/I have not applied for the connection of those services in this application.  This consent will continue [for a period of 1 year from the date of our/my execution of this application/until [28] days after we/I disconnect the last of the services in respect of which this application is made]; acknowledge that this consent will permit Direct Connect to contact us/me even if the telephone numbers listed on this application form are listed on the Do Not Call Register; understand that under the requirements of the Privacy Act 1988, Direct Connect will ensure that all personal information obtained about me/us will be appropriately collected, used, disclosed and transferred and will be stored safely and protected against loss, unauthorised access, use, modification or disclosure and any other misuse; authorise the obtaining of a National Metering Identifier (NMI) for my residential address to obtain supply details; con
sent to Direct Connect disclosing my/our details to utility providers (including my/our NMI and telephone number); declare and undertake to be solely responsible for all amounts payable in relation to the connections and/or supply of the Services and hereby indemnify Direct Connect and its officers, servants and agents and hold them indemnified against any charges whatsoever in respect of the Services; acknowledge that, to the extent permitted by law, Direct Connect shall not be liable for any loss or damage (including consequential loss and loss of profits) to me/us or any other person or any property as a result of the provision of the services or any act or omission by the utility provider or for any loss caused by or in connection with any delay in connection, disconnection or provision of, or failure to connect or disconnect or provide, the nominated utilities; acknowledge that whilst Direct Connect is a free
By signing this application form, I warrant that I am authorised to make this application and to provide the consents, acknowledgements, authorisations
Signature:  Date:
Property Manager Name:
X
8/8/2013
6. Previous Residence Information continued
7. Other Information
8. Current Employment Details
9. Previous Employment Details
10. Personal Referees
(not emergency contact)
Details if home owner Was this home Sold
Rented
Retained
Details of Selling/Lease Agent
Agent Name Contact Phone
Length of stay Years
Months
Reason for Moving
Number of persons occupying property Adults
Children
Please specify the ages of any children Do you have pets? Yes
No
Type of Pet If Yes, please specify Breed Motor Vehicle Yes
No
Make/Model
Rego No
Emergency contact (not living with you) -
Name:Relationship Phone
Address
Employment Address Suburb  Post Code
Contact Name
Phone Length at Current employment?  Years Months Net Income? Per Week Per Month
Fulltime
Part Time
Casual
Occupation Employers Name Employment Address Suburb  Post Code
Contact Name
Phone Length at Previous employment?  Years Months Net Income? Per Week Per Month
Fulltime
Part Time
Casual
11. Business Referees
TENANT PRIVACY STATEMENT
We accept:Please nominate your preferred ongoing rent payment method:
Automatic debit payments from your credit card OR Direct debit from my nominated bank account
(further forms will be required upon signing your tenancy agreement)
I acknowledge that this is an application to lease this property and that my application is subject to the owner’s approval and the availability of the premises on the due date.  No action will be taken against the landlord or agent if the application is unsuccessful or upon acceptance should the premises be una
vailable for occupation on the date for whatever reason.  I hereby offer to rent the property from the owner under a lease to be prepared by the Agent.  I acknowledge that I will be required to pay rental in advance and a rental bond, and that this application is subject to approval from the owner/landlord.  I declare that all information contained in this application is true and correct and given of my own free will.  I declare that I have inspected the premises, I am over the age of 18 and I am not bankrupt.
I authorise Domain Property Advocates to perform credit and reference checks in relation to my application.Signature X
Date            /            /
All Property Managers must ensure that you fully understand the National Privacy Principles and the manner in which we must use your private information in order to carry out our role as professional Property Managers.  Please take the time to read this Privacy Statement carefully and once completed, return it to our office.As professional Property Managers Domain Property Advocates collects personal information about you.  To ascertain what personal information we have about you, you may contact us.
Primary Purpose
As professional property managers, we collect your personal
information to assess the risk in providing you with the lease / tenancy of the premises you have requested and if the risk is considered acceptable, to provide you with the lease / tenancy of the premises.To carry out this role and during the term of your tenancy, we may disclose your personal information to:•  The Landlord
•  The Landlord’s lawyers
•  The Landlord’s mortgagee / insurer’s •  Referees you have nominated •  O rganisations / Trades people required to carry out maintenance to the premises •  Rental Bond Authority
•  Residential Tenancy Tribunals/Courts •  Mercantile Agents •  N ational Tenancy Database Pty Ltd  (ABN 65 079 105 025) (“NTD”)
•  Other Real Estate Agents & Landlords
Secondary Purpose
We also collect your personal information to
1.  E nable us, or the Landlord’s lawyers, to prepare the lease/tenancy documents on the premises.
2.  A llow organisations/tradespeople to contact you in relation to maintenance matters relating to the premises.
3.  P ay/release rental bonds to/from Rental Bond Authorities (where applicable)
4.  R efer to Tribunals, Courts and Statutory Authorities (where necessary).
5.  R efer to Collection Agents/Lawyers (where default/enforcement action is required).
6.  P rovide confirmation details for organizations contacting us on your behalf ie banks, utilities, employers etc.If your personal information is not provided to us and NTD, and you do not consent to the uses to which we put your personal
information; we cannot properly assess the risk to our client, or carry out our duties as professional property managers.
Consequently, we may not provide you with the lease/tenancy of the premises.
NTD Disclosure Statement
You can contact National Tenancy Database Pty Ltd  (ABN 65 079 105 025) (“NTD”) by:Telephone: (03) 8629 1682 Facsimile: (03) 8629 1650 Email: au Visit website: d.au Postal Address: The Manager  National Tenancy Database Pty Ltd  Level 12, 628Bourke Street  Melbourne  3000
Proof of identity will be required, i.e., photo licence, passport etc.
Primary Purpose
NTD collects your personal information to provide to its members historical tenancy and location information on individuals and companies who/which lease residential and commercial property from or through licensed real estate agent members of NTD.NTD also provides credit information on companies/directors applying for commercial leases.
The real estate agent / property manager will advise NTD of your conduct throughout the lease / tenancy, and that information will form part of your tenant history.
NTD usually discloses information to:
•  Licensed real estate agent members •  N TD’s parent company, Collection House Limited  (ABN 74 0
10 230 716) and its subsidiaries  •  Credit Bureaus Signed by the Tenant:(Signature)(Print Name)
Date
Month
Year

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