Delaware Rental Application Form

Pre-tenancy application form
Please complete this form to apply for tenancy at the address below. The information you
provide is for applying for this tenancy and may be used for a credit and reference check.
Your privacy is protected under the Privacy Act 1993.
Tenancy details
Property address:
Commencement of tenancy:
Date:
/
/
Applicant details
Full name:
Phone number:
Date of birth:
/
Mobile phone:
Email:
Current address:
How long have you lived there?
Years:
Months:
Please state why you are leaving this address:
Identification
Please provide photo identification, such as your driver’s licence or passport.
Driver’s licence or passport number:
Version no. (if applicable)
Car/vehicle registration number:
Make and model:
Alternative form of ID:
Emergency contact
Name:
Address:
Phone number:
Email:
Mobile phone:
/
Current landlord’s details
If you are currently renting, please provide your landlord’s name and contact details.
Landlord’s name:
Phone number:
Mobile phone:
Email:
May I contact this person for a reference?
Yes / No
(Please check)
References
Please provide two referees that I can contact. Referees can be a friend, co-worker, your
employer or someone who knows you well.
One of your referees should be able to provide a reference about your credit worthiness. If
you have already provided your current landlord’s details, only one additional referee is
needed. Please let these people know I may be contacting them for a reference.
Referee name 1:
Phone:
Email:
Referee name 2:
Phone:
Email:
Signature
I authorise the Landlord/Property Manager to:

collect, retain and use this information for the purpose of assessing my
creditworthiness; and

disclose information about me, whether collected from me directly or from any other
source, to any other credit provider or any credit reporting agency for the purposes of
providing or obtaining a credit reference.
Signed by:
Date signed:
Under the Privacy Act 1993, you have the right to ask for a copy of all information
held about you, and have the right to request the correction of any incorrect information.