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Property Address*
Date you wish to move in*
Full name(s)*
Date of birth*
Identification number and expiry date (Drivers Licence or Passport)*
Phone Number*
Mobile Number
Email Address*
Current Address*
Length of time at Current Address*
Agent/Landlord*
Agent/Landlord Contact Number*
Reason for Leaving*
Occupation*
Full time, part time or casual*
Period of Employment*
Current Employer*
Address of Current Employer*
Employer contact details if available for reference
If you own a motor vehicle please complete the following:
Make/Model
Registration Number
Name*
Phone*
Email Address
Address*
Relationship to you*
Name
Occupation and Employer
Current Address
Phone
Do you have any pets?YesNo
Do any of the intended occupants smokeYesNo
I/we authorise any authorised person of Gerald Harbinson Real Estate Limited to obtain from any person or company any information that you may require to consider my/our tenancy application. I/we further confirm that the information provided in this application is true and correct.
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