Residential Application Form

For your application to be processed you must answer all questions

(Including the reverse side)

A. AGENT DETAILS D. UTILITY CONNECTIONS

This is a free service that connects all your utilities
Professionals Ballarat
612 Sturt Street,
Ballarat VIC, 3350
Once we have received this application we will call you to confirm your details.
Phone: (03) 5333 2040 Fax: (03) 5333 1560 Direct Connect will make all reasonable efforts to contact you within 24 hours of the nearest working
Website: www.professionalsballarat.com.au day on receipt of this Application to confirm the information on this Application and explain the details
of the services offered. Direct Connect is a utility one stop connection service.
Please tick utilities as required
Electricity Phone Internet Pay TV
B. PROPERTY DETAILS
Gas Water Insurance
1. What is the address of the property you would like to rent? DECLARATION AND EXECUTION: By signing this application, I/we: consent to Direct Connect
arranging for the connection and disconnection of the nominated utility services and to providing
information contained in this application to utility providers for this purpose; acknowledge having been
provided with terms and Conditions of Supply of Direct Connect and having read and understood them
together with the Privacy Collection Notice set out below; declare that all the information contained
Postcode in this application is true and correct and given of their own free will; expressly authorise Direct
Connect to provide any information disclosed in this Application to a supplier or potential supplier of
the Services in accordance with the Privacy Collection Notice and to obtain any information necessary
2. Lease commencement date? in relation to the Services; expressly authorise Direct Connect to provide any information disclosed in
this Application to an information provider for the purpose of that information provider disclosing it to
a supplier or potential supplier of the Services in accordance with the Privacy Collection Notice and
Day Month Year to obtain any information necessary in relation to the Services; consent to Direct Connect contacting
me by telephone or by SMS in relation to the marketing or promotion of all of the services listed
under the heading “Utility Connections” above even if we/I have not applied for the connection of
3. Lease term?
those services in this application. This consent will continue [for a period of 1 year from the date
of our/my execution of this application/until [28] days after we/I disconnect the last of the
Years Months services in respect of which this application is made]; acknowledge that this consent will permit
Direct Connect to contact us/me even if the telephone numbers listed on this application form are
listed on the Do Not Call Register; understand that under the requirements of the Privacy Act 1988,
4. How many tenants will occupy the property? Direct Connect will ensure that all personal information obtained about me/us will be appropriately
collected, used, disclosed and transferred and will be stored safely and protected against loss,
unauthorised access, use, modification or disclosure and any other misuse; authorise the obtaining
Adults Children of a National Metering Identifier (NMI) for my residential address to obtain supply details; consent
to Direct Connect disclosing my/our details to utility providers (including my/our NMI and telephone
number); declare and undertake to be solely responsible for all amounts payable in relation to the
C. PERSONAL DETAILS connections and/or supply of the Services and hereby indemnify Direct Connect and its officers,
servants and agents and hold them indemnified against any charges whatsoever in respect of the
5. Please give us your details Services; acknowledge that, to the extent permitted by law, Direct Connect shall not be liable for
any loss or damage (including consequential loss and loss of profits) to me/us or any other person
Mr Ms Miss Mrs Other or any property as a result of the provision of the services or any act or omission by the utility
provider or for any loss caused by or in connection with any delay in connection, disconnection or
provision of, or failure to connect or disconnect or provide, the nominated utilities; acknowledge
Surname Given Name/s that whilst Direct Connect is a free service I/we may be required to pay standard connection fees
or deposits required by various utility providers; acknowledge that the Services will be provided
according to the applicable regulations and that the time frames and terms and conditions of the
nominated utility providers bind me/us and that after hours connections may incur additional service
fees from utility providers; acknowledge that the real estate agent listed on this application form
Date of Birth Driver’s licence number
may receive a benefit from Direct Connect in connection with the provision of the service being
provided to me/us by Direct Connect; and acknowledge the entitlement of Direct Connect and its
associates, agents and contractors, to receive a fee or remuneration from the utility provider and
that such fee or remuneration will not be refunded to me as a rebate in connection with the provision
of the utility connection services.
Driver’s licence expiry date Driver’s licence state
By signing this application form, I warrant that I am authorised to make this
application and to provide the consents, acknowledgements, authorisations
and other undertakings set out in this application form on behalf of all
Passport no. Passport country applicants listed in this application form.
Signature Date

Pension no. (if applicable) Pension type (if applicable)

PO Box 1519, Box Hill, Victoria 3128. P: 1300 664 715 F:1300 664 185. www.directconnect.com.au
E. DECLARATION
I hereby offer to rent the property from the owner under a lease to be prepared by the Agent. Should
this application be accepted by the landlord I agree to enter Into a Residential Tenancy Agreement.
6. Please provide your contact details
I acknowledge that this application is subject to the approval of the owner/landlord. I declare that all
Home phone no. Mobile phone no. information contained in this application (including the reverse side) is true and correct and given of
my own free will. I declare that I have Inspected the premises and am not bankrupt.
I authorise the Agent to obtain personal Information from:
(a) The owner or the Agent of my current or previous residence;
(b) My personal referees and employer/s;
(c) Any record listing or database of defaults by tenants such as NTD, TICA or TRA for the
Work phone no. Fax no. purpose of checking your tenancy history;
I am aware that I may access my personal information by contacting -
• NTD: 1300 563 826
• TICA: 1902 220 346
• TRA: (02) 9363 9244
Email address If I default under a rental agreement, I agree that the Agent may disclose details of any such
default to a tenancy default database, and to agents/landlords of properties I may apply for in the
future.
I am aware that the Agent will use and disclose my personal information in order to:
7. What is your current address? (a) communicate with the owner and select a tenant
(b) prepare lease/tenancy documents
(c) allow tradespeople or equivalent organisations to contact me
(d) lodge/claim/transfer to/from a Bond Authority
(e) refer to Tribunals/Courts & Statutory Authorities (where applicable)
Postcode (f) refer to collection agents/lawyers (where applicable)
(g) complete a credit check with NTD (National Tenancies Database)
(h) transfer water account details into my name
I am aware that if information is not provided or I do not consent to the uses to which personal
Property Manager Name information is put, the Agent cannot provide me with the lease/tenancy of the premises.
Signature Date
Application Fax to
Direct Connect (If Required)
F. APPLICANT HISTORY H. CONTACTS / REFERENCES
8. How long have you lived at your current address? 16. Please provide a contact in case of emergency
Surname Given name/s
Years Months
9. Why are you leaving this address?
Relationship to you Phone no.

10. Landlord/Agent details of this property (if applicable)

Name of landlord or agent 17. Please provide 2 personal references (not related to you)
1. Surname Given name/s

Landlord/agent’s phone no. Weekly Rent

Relationship to you Phone no.
$
11. What was your previous residential address?
2. Surname Given name/s

Postcode
Relationship to you Phone no.
12. How long did you live at this address?

Years Months
I. OTHER INFORMATION
13. Landlord/Agent details of this property (if applicable)
18. Car Registration
Name of landlord or agent

19. Please provide details of any pets

Landlord/agent’s phone no. Weekly Rent Breed/type Council registration / number

$ 1.

Was bond refunded in full? If not why not? 2.

PLEASE NOTE
Initial payments must be made by cash, bank cheque or money order
G. EMPLOYMENT HISTORY within 24 hours after approval of application. No Personal Cheques
14. Please provide your employment details accepted.
What is your occupation?
Keys will not be handed over until the lease agreement has been
signed by all applicants.

What is the nature of your employment?

This application is accepted subject to the availability of the property
(FULL TIME/PART TIME/CASUAL) on the due date and no action shall be taken by the applicant against
the landlord and the agent should any circumstances arise whereby the
Employer’s name (inc. accountant if self employed or institution if student) property is not available for occupation on the due date.

HOW DID YOU FIND OUT ABOUT THIS PROPERTY?

The Age The Internet Local Paper
Employer’s address
Board Counter List Relocation Company
Referral Other (specify)
Postcode
PLEASE PROVIDE US WITH 100 POINTS OF IDENTIFICATION
Contact name Phone no. Driver’s Licence 50

Passport 50
Length of employment Net Income Proof of Age Card 50
Years Months $ Student ID Card 50

15. Please provide your previous employment details Copy of Mobile Phone Account 20
Occupation?
Copy of Medicare Card 20

Concession / Pension Card 10

Employer’s name
Copy of gas/Water/Electricity account 30 each

OFFICE USE ONLY

Length of employment Net Income Property Rental

Years Months $ $ per week $ per month