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43 Ryrie Street, Geelong, 3220 Member of the Phone 5229 4702 Fax 5223 2989 Real Estate Institute of Victoria Provide a copy of your drivers licence or passport Use one application per person Attach written references to this application The first rental payment must be made by CASH or BANK CHEQUE The bond payment is to be made by BANK CHEQUE, payable to the Residential Tenancies Bond Authority.PROPERTYStart DateRent - weeklyRent - four (4) weeklyBondTerm of lease (months)APPLICANT NAME IN FULL (Mr / Mrs / Miss / Ms / Dr)Phone (BH)Phone (AH)MobileDate of BirthCurrent AddressNo. of occupants (adults)No. of occupants (children)Ages of childrenPets? Yes / No (If yes, what type?)IDENTIFICATIONDrivers Licence no. (copy attached) Medicare no. - Passport no. (copy attached) - Please indicate state of licence / country of passport)CURRENT LANDLORD / AGENTPhone (BH)ContactPhone (AH)Rental addressCurrent Rental $Reason for leavingLength of stayPREVIOUS LANDLORD / AGENT - if under 2 yearsPhone (BH)ContactPhone (AH)Rental addressLength of stayRental $CURRENT OCCUPATION / JOB DESCRIPTIONCurrent EmployerContactEmployers AddressPhone no.Employed sinceIncome $PREVIOUS OCCUPATION / JOB DESCRIPTION - if under 2 yearsPrevious EmployerContactEmployers AddressPhone no.Employment periodIncome $PERSONAL REFERENCEName, address and phone numberEMERGENCY CONTACT Next of KinRelationshipPhone no.AddressI accept that the Real Estate Agency may conduct independent reference and credit checks on this application.Signature of applicantDatedT. N. JOLLYS REAL ESTATE PROPERTY MANAGEMENT DIVISIONAs professional property managers, T. N. JOLLYS REAL ESTATE collects personal information about you. To ascertain what personal information we have about you, you can contact us by:Telephone :52 294702Fax :52 232989Email :.auThis information will be made available from 21 December 2001.PRIMARY PURPOSE :As professional property managers, we collect your personal information to assess the risk in providing you with the lease/tenancy of the premises you have requested, and if the risk is considered acceptable, to provide you with the lease/tenancy of the premises/property.To carry out this role, and during the term of your tenancy, we usually disclose your personal information to :The Landlord The Landlords lawyers The Landlords mortgagee Referees you have nominated Organisations/Trades people required to carry out maintenance to the premises/property Rental Bond Authority Residential Tenancy Tribunals( V. C. A. T. )/Courts of Law Debt Collection Agents TICA Default Tenancy Control Pty. Ltd. ( TICA ) Other Estate Agents and LandlordsSECONDARY PURPOSES : ( Please note: Your application cannot be processed without this form )We also collect information to :Enable us, or the Landlords lawyers, to prepare theLease/tenancy documents for the premises/propertyqAllow organisations/trades people to contact you inRelation to maintenance matters relating to the propertyqPay/release rental bonds to/from Rental BondAuthority ( where applicable)qRefer to Tribunals, Courts of Law and StatutoryAuthorities ( where necessary)qRefer to Collection Agents/Lawyers ( where default/Enforcement action is required )qProvide confirmation details for organisations contactingUs on your behalf, eg. Banks, Utilities ( Gas, Power,Water, Phone ), Employers etc.qPlease place a tick in each box if you consent to use and disclosure.If your personal information is not provided to us, and you do not consent to the uses to which we put your personal information, we cannot properly assess the risk to our client, or carry out our duties as professional property managers. Consequently, we then cannot provide you with the lease/tenancy of the premises/property.TICA Default Tenancy Control Pty. Ltd. ( TICA) DISCLOSURE STATEMENTTICA is a company registered in New South Wales and operates throughout Australia, New Zealand and the United Kingdom.TICA has established a public inquiry telephone number which is 190 222 0346. Calls to this number are charged at $5.45 per minute GST inclusive. Or you can write to TICA and enclose a money order or bank cheque for $11.00 to obtain your information. When making an inquiry please remember to include your full name, date of birth, drivers licence number and current address. A reply can take up to 14 days.Any breach that may occur throughout a tenancy can be reported to TICA, from arrears of rent to poor periodic inspections. A full list of reasons for reporting can be found on the TICA web-site at .au within the tenant information area.Any information held on the TICA database is for the exclusive use of TICA members and only used in the evaluation of a tenancy application. No other person or corporation other than those involved in the rental accommodation industry has access to the information held by TICA.Privacy Act AcknowledgementIn accordance with Privacy Principle 1.3 of the Privacy Act we require you to read and sign this acknowledgement. In order to process a tenancy application a tenancy applicant is required under the National Privacy Principles of the Privacy Act to be made aware that an organisation may access a database. In addition an approved tenant is entitled to know what will happen to their information when it is passed onto an agent.I/we the said applicant/s declare that I/we give permission to T. N. Jollys Real Estate to collect my/our information and pass such information onto TICA Default Tenancy Control Pty. Ltd. I/we give further permission for my/our information to be provided to any other tenancy database for the assessment of the tenancy application.I/we agree and understand that once the tenancy application has been lodged with T. N. Jollys Real Estate and an inquiry made with a database my/our information may be recorded as making an inquiry.I/we understand that in the event of a default occurring under a tenancy agreement I/we give my/our permission for T. N. Jollys real Estate to register any of my details with a tenancy database. I/we further agree and understand that the removal of such information is subject to the conditions of the Database Company.I/we understand that TICA is a database company that allows its members access to information accumulated from members about tenants and approved

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