Application Form

A. Personal Details
1. Full Name (including title):
2. Date of Birth:
3. Passport Number:
4. NI Number :
5. Telephone Number :
6. Email Address:
A. Next of Kin:
NOK Name
Tel number
Address:
B.Where do you currently reside?
1. Current Address (including Postcode):
2. Status:
If renting current rent
	Per Week
	Per Month
3. Dates at current address:
from
to
C. Current Landlord
1. Name of Current Landlord:
2. Address of Current Landlord:
3. Telephone Number:
4. Email Address:
If less than 3 years please provide previous addresses & dates of residence for last 3 years:
1 Telephone Number
2 Email
3 Name of Landlord
E. Current Employment Details
1. Name of Current Employer:
2. Address of Current Employer:
3. Telephone Number:
4. Email Address:
5. Position Held:
6. Your Salary:
7. Date Employment Commenced:
8. Contact Name & Position:
9. National Insurance Number:
10. Employment Type:
G. Bank / Building Society Details
1. Bank Name & Branch Address:
2. Account Holder Name:
3. Account Number:
4. Sort Code:
H. Other Income
Are you in receipt of any of the following?
K. Other Details
1. Are you a smoker?
2. Do you have any pets? If so what?
3. Are you pregnant?
4. Have you suffered from any mental health issues in the last 24 months?
4. Past or present - Disclose any County Court Judgement, IVA, Debt relief orders, Bankruptcy or similar.
5. Have you had any criminal convictions?
6. Nationality
L. Declaration
I hereby confirm that I am over 18 years of age and the information I have provided is to the best of my knowledge true and accurate at the time of completion and hereby authorise the landlord or their agent to: carry out credit searches and reference checks, to contact employers, banks, referees, guarantors and credit reference agencies as appropriate. use the information obtained with third parties to assess credit ratings, make insurance decisions, for fraud prevention and tracing / debt collection. Handle all information obtained in strictest confidence and in accordance with the principles of the Data Protection Act 1988. I acknowledge that my application may be refused if the landlord is unable to obtain satisfactory references. I accept that due to the confidential nature of this application, I will not be permitted access to the references or be given any explanation should my references prove unsatisfactory.

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