Application Form

Here is the application form for a room. I wouldn't recommend filling this in until we have met you, but if you're really, really keen… ;)

Pre-tenancy application form

To apply(1) for a room at the below address we need the following information(2). This allows us to check your references, credit history and gives us the information required to create a contract. The result of the credit check will determine the amount of bond required if tenancy is offered to the applicant.

Please return the information to the senders email address or to: moc.talfnotgnillew|moor#moc.talfnotgnillew|moor. Please note that you can download a paper version of these questions from and send to: 1 Carrington Drive, Carterton, Wairarapa. We recommend applying via email as it speeds up your application process. See for detailed information about our services and a list of available rooms.

The information you supply is protected under the Privacy Act 1993.

Tenancy details:

Property address:
Room #:
Commencement of tenancy (dd/mm/yyyy):

Applicant details

Full name:
Date of Birth (dd/mm/yyyy):
Mobile phone:

Current address:
How long have you lived there?

  • Years:
  • Months:

Please state why you are leaving this address:

Place of Employment / Study:

Next of Kin (used in case of emergency):

  • Name:
  • Contact Details:


  • Do you require the use of the telephone? Yes / No
  • What Internet data cap would you like1? x Gb

1 See


Type (eg driver’s licence or passport number, must be photo id):
Driver's License Version:
(Version is only required if you are providing details of a driver's license. It is section 5B, eg 002).

Car/vehicle registration number:
Make and model:

Alternative form of ID:

Emergency contact

Phone number:
Mobile phone:

Current landlord’s details

If you are currently renting, please provide your landlord’s name and contact details.
Landlord’s name:
Phone number: Mobile phone:

May I contact this person for a reference? Yes / No


Please provide two referees that I can contact. Referees can be a friend, co-worker, your employer or someone who knows you well.

One of your referees should be able to provide a reference about your credit worthiness. If you have already provided your current landlord’s details, only one additional referee is needed. Please let these people know I may be contacting them for a reference.

Referee name 1:

  • Phone:
  • Email:

Referee name 2:

  • Phone:
  • Email:

Where did you find out about the room?

TradeMe | NZFlatmates | Google Search | Non-Google Web Search | Friend | Other (Please Specify)


I have read and understood this application form. I agree to this information being used as necessary to obtain personal references and a credit check.

Signed by(3): Date signed(3):


(1) Application for tenancy does not guarantee that tenancy will be offered.
(2) You are responsible for ensuring that the information you provide is true and correct before you send this information. Any missing information, sections or questions will render this application invalid.
(3) Please enter your name and the date. By doing so you agree to the terms and conditions listed in the above document.

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