This form contains 35 fields organized into 14 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Applicant Contact Details
Applicant Phone Number Text
Please enter the applicant's primary phone number.
Applicant Mobile Phone Number Text
Please enter the applicant's mobile phone number.
Applicant Email Address Text
Please enter the applicant's email address.
Current Address
Current Address Line 1 Text
Please provide the first line of your current address.
Current Address Line 2 Text
Please provide the second line of your current address.
Current Landlord's Details
Landlord's Name Text
Enter the full name of your current landlord.
Phone Number Text
Enter the primary phone number of your current landlord.
Mobile Phone Number Text
Enter the mobile phone number of your current landlord.
Email Text
Enter the email address of your current landlord.
Date of Birth
Date of Birth Day Date
Enter the day of your birth.
Max length: 2 characters
Date of Birth Month Date
Enter the month of your birth.
Max length: 2 characters
Date of Birth Year Date
Enter the year of your birth.
Max length: 4 characters
Duration at Current Address
Years at Current Address Text
Enter the number of years the applicant has lived at the current address.
Max length: 2 characters
Months at Current Address Text
Enter the number of months the applicant has lived at the current address, in addition to full years.
Max length: 2 characters
First Referee Details
First Referee Name Text
Enter the full name of the first referee.
First Referee Phone Text
Provide the phone number for the first referee.
First Referee Email Text
Enter the email address for the first referee.
Full Name
Full Name Text
Enter the applicant's full name.
General
0150 Text
0151 Text
Identification
Driver's Licence Number Text
Please provide your driver's licence number.
Driver's Licence Version Number Text
Please provide the version number of your driver's licence, if applicable.
Alternative Form of ID Text
Please provide details of an alternative form of identification.
Reason for Leaving Address
Reason for Leaving Address Text
Please provide the reason for leaving your current address.
Reference Contact Permission
Yes Checkbox
Check this box if the landlord or agency is permitted to contact this person for a reference.
No Checkbox
Check this box if the landlord or agency is not permitted to contact this person for a reference.
Second Referee Details
Second Referee Name Text
Enter the full name of the second referee.
Second Referee Phone Number Text
Enter the phone number of the second referee.
Second Referee Email Address Text
Enter the email address of the second referee.
Signature
Date Signed Date
Enter the date the form was signed.
Tenancy Details
Property Address Text
Enter the full street address of the property for which you are applying to rent.
Commencement of Tenancy Details Text
Provide any specific details or conditions related to the commencement of the tenancy.
Tenancy Commencement Day Text
Enter the day of the month for the tenancy's start date.
Max length: 2 characters
Tenancy Commencement Month Text
Enter the month for the tenancy's start date.
Max length: 2 characters
Tenancy Commencement Year Number
Enter the year for the tenancy's start date.
Max length: 4 characters