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501a Port Road, PO Box 148 Whangamata Holiday Homes: 07 865 7990 Permanent Rentals: 07 865 7960

Please fill the form below. If you prefer a printed version, click here to download.
Fill the form and fax it to 07 865 7490

Application for Residential tenancy


PHOTO ID – Drivers licence or passport = 20 Points
PROOF OF ADDRESS - Phone bill, Electricity bill, Car registration, Tax Return = 20 Points
PROOF OF INCOME – Pay slips, WINZ confirmation statement, Bank Statement = 20 Points
CONFIRMATION OF RENT PAYMENTS – Rents receipts or Agency confirmation = 20 Points
CREDIT CHECK - Obtained through First National $20 Incl GST = 20 Points

Please complete this form to apply for a Tenancy. The information you provide is for the purpose of
applying for a Tenancy only and may be used for a credit and reference check. Your privacy is
protected under the Privacy Act 1993.
Personal information is collected from tenants or potential tenants in the course of a Tenancy
Application and any subsequent Tenancy as is necessary for Whangamata Rental s to verify the
potential tenants identity and to process and evaluate the application and to manage the

I/we acknowledge and understand that it is the policy of Whangamata Rentals to hold this
application open for 30 days and may retain this application if the application has not been

Privacy Acknowledgement

I/we acknowledge that personal information collected in the application and during the course of
the Tenancy, including previous tenant history, credit worthiness, credit standing or capacity,
gained through property inspection reports, or other means may be disclosed to other parties
including the Landlord, Employment and Other referees, as well as Trades people, Government
and Statutory Authorities, Financial institutions and other agents and operators of Tenancy
reference databases and to third parties as required by law.

I/we acknowledge that if the applicant fails to comply with their obligations u nder the Tenancy
Agreement, that fact may be disclosed to the Landlord, and other agents.

I/we agree that should I/we fail to provide Whangamata Rentals with the information and
acknowledgements it may not proceed with my/our Tenancy Application.


Applicant Name Signature Date: (MM/DD/YY)

Applicant Name Signature Date: (MM/DD/YY)

Property Name


Print Full name (include middle names)

Date of Birth (MM/DD/YY) Occupation

Wife/Husband/Partners name:

No of children
Names & Ages:

Mobile: Work: Home:


Upload you photo ID here

Name Employer/Benefit Phone

Period of Employment/Benefit Nett Weekly Income $

Your current address:

Do you own it? or are you Renting/Boarding.
If No what is the weekly Rent/Board $. How long have you lived there? Years: Months:

Please state why you are leaving this address?

Do you or any person who will occupy the premises smoke?

Have you had a Previous Tenancy Terminated?

Do you owe money to any landlord for any reason?

Have you previously had money ever deducted from your bond?

Any Criminal Convictions last 5 yrs, Court Cases pending?

Do you own a lawnmower?

Total number of vehicles to be kept on property?

When do you want the tenancy to begin?

Please provide your landlord’s or person you board with, name and contact details .


Day Phone Night Phone Mobile

Office Use.. Fast Connect?


Business Reference 1 Relationship Phone

Business Reference 2 Relationship Phone

Personal Reference 1 Relationship Phone

Personal Reference 2 Relationship Phone

Name and address of Relative (NOT living with you)

Relationship Phone

Name and address of Next of Kin (NOT living with you)

Relationship Phone

If necessary do you have someone who can act as guarantor?

Housing Requirements

No Bedrooms: Carport/Garage: Fenced

No Occupants: Adults Children Pets (dogs/cats) Type of dog/cat

Furn/Unfurn Max Rent $


I/we have read and understood and completed this application form. I/we agree to this
information being used as necessary to evaluate and process this application.

1. Signed Date (MM/DD/YY)

2. Signed Date (MM/DD/YY)

Code verification


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