If currently renting, please provide landlord/property manager details below
Close Relatives Details
Source of Income
Please provide two referees (including telephone numbers) that we can contact.
Referees can be a friend, someone you have worked with, your case manager, your employer
or someone from your community who knows you well.
One of your referees should be someone who can provide a reference about your credit worthiness. If you have already provided your current landlords details above, one additional referee is enough. Please let these people know we may be contacting them for a reference about you.
I hereby appoint you to act as my agent to arrange rental accommodation for me. By introducing me to the premises for which I am applying, should it lead to me taking a tenancy of the same premises, I undertake to pay a deposit, being equivalent to
2 weeks rent not withstanding that you may also be engaged as the management agent by the landlord.
I agree to pay the deposit within 2 days of confirming to rent an agreed property from you. If this deposit is not paid within the 2 days, I
understand that I have forfeited the property. Once I have paid the deposit, should I change my mind and not want the property, I understand and agree that the deposit is not refundable or transferable and therefore forfeited by me.
Should at any stage between now and commencement of the tenancy, the Landlord and/or Letting Agent decide not to let the above
property to you, your deposit may be partly or fully refunded depending on the circumstances.