Waiuku Rentals & Property Management Ltd

TENANCY APPLICATION FORM

Property Applied For  HIV226

Applicant Name Marco Antonio Lozada DOB

11/09/1986
Current Address
9a Parvin Place, Pukekohe

Length of Residence Reason for moving:

1 10 We need a bigger house where we will have space to have a
Yrs Months office and be able to work from home
Contact No’s Home Work Cell
0277561987 0272222432 0277561987
Email Address lozagro@gmail.com
Identification Drivers Licence No Version No.
Joint Applicant Name
Ana Maria Weiss Iarczewski
Current Address 9a Parvin Place, Pukekohe

Length of Residence Reason for moving:

1 10 We need a bigger house where we will have space to have a
Yrs Months office and be able to work from home
Contact No’s Home Work Cell
0277321456
Email Address Ana.iarczewski@gmail.com
Identification Drivers Licence No – DV560436 Version No 701
Number of Ages of children
Children No Children
Do you have Pets? If yes please give details ( i.e type, breed, number of pets)
Yes
Cat, Moggy, 2

Applicant 1 - Employer Applicant 2 - Employer

Company Company

Length of Length of
Employment: Yrs Mths Employment: Yrs Mths

Current Landlord Name :

Contact Number/s

Email:
May I contact this person for a reference? Yes/No
Please circle

Previous Landlord Name:

Address of Property Rented:

Contact Number/s
Email:
Other Referees: This may be an employer, a colleague, or someone else who knows you well
and can provide a character reference for you if required

Name: Contact Number:

Relationship to you:

I authorise the Landlord/Property Manager to:

- Collect, retain and use this information for the purpose of assessing my creditworthiness and
suitability for the tenancy; 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 report (which will involve the credit reporting agency providing information
about me to the landlord/Property Manager).

I understand that the credit reporting agency:

- May hold my information in their credit reporting database and use it for providing credit
reporting services, and they may disclose my information to their subscribers for the purpose of
credit checking or debt collection: and
- As part of providing a credit report, may check the Ministry of Justice fines database for any
overdue fines I may have

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