This application form collects personal information about you.
This information is required to:
• Assess your eligibility as a tenant; and
• Collect information, which would be provided to a tenant default database and/or credit bureau if you enter into a tenancy agreement and fail to comply with the terms of that agreement. ( A tenant default database records the names of the persons who have been found in breach of their tenancy agreement and/or the Residential Tenancies Act 1986 by the Tenancy Tribunal);
• This information in this tenancy application form will be retained within our office;
• The information will also be made available to credit bureau and/or tenant default databases and will be accessible to other people that may inquire of this credit bureau and/or tenant default database;
• If you do not supply all the information in this form, you may not be considered for my/our tenancy(ies)
• You have a right to see the information held about you by any credit bureau or tenant default database and to correct that information in accordance with the Privacy Act.
Acceptance
1. I consent to you providing the information in this form and details of any proven breach of
my tenancy agreement or of the Residential Tenancies Act 1986 to any credit bureau or
tenant default database.
2. I acknowledge that the information may then be made publicly available through credit
bureaux or tenant default databases.
3. I agree that you may use any of the information on this application form to enforce any
judgement in respect of the tenancy agreement or in respect of any order against me by the
Tenancy Tribunal.

4. I agree that an assessment regarding my fulfilment of basic tenant responsibilities may be added to an internet based tenant reference website. This assessment will be about how I/We
• Payment of rent
• Kept the dwelling and grounds tidy
• Were considerate towards neighbours
• Left the dwelling and grounds tidy
• If we are declined a tenancy – for any reason.
5. I confirm the information in this form is true and correct and that I have read the Privacy Act Statement as stated above.