First National Port Vila
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Renting
Application Form
Tenancy Application
Date 09 Sep 2010

Property Applying For
Address *
Suburb *
Rent per week $ *
Bond $ *

Your Details
Full Name *
Email Address *
Date of Birth *
Status Single
Married
Solo
Defacto
Please state who else will be residing with you
Name
Relationship
Age
Name
Relationship
Age
Name
Relationship
Age
Are you, or any of the above stated, smokers? Yes No
Your current address *
Your contact phone numbers
Home *
Work
Mobile
Previous Address
Your Occupation *
Currently employed with *
Do you have rental references? Yes No
What type of accomodation do you require?
(eg. House, Flat? No of Bedrooms? Garage?)
Maximum rent you can afford $
When do you need a place by?
Have you any pets? Yes No
Drivers Licence Number
Name of next of kin
Contact Ph No
Additional Comments
By pushing the submit button below, I authorise that the above information may be used to carry out a credit check on me. I also agree that should I be in breach of any express or implied provision of the tenancy agreement or any provision of the residential Tenancies Act, that I will pay the Landlord's costs's incurred in undertaking collection action to recover his/her losses.
    
* Indicates mandatory fields

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