Application for Occupation Contract

Please note that all fields followed by an asterisk must be filled in.

Proposed Tenancy Address*

Proposed Starting Date of Tenancy*

Last Name*

First Name*

Street Address*

City*

Zip/Postal Code*

Country

E-Mail Address*

Home Phone

Date of Birth*

Place of Birth*

Nationality*

N I Number

Occupation*

Present Landlord Contact Details*

Tenancy Length

Previous Landlord Contact Details

Previous Tenancy Length

Proposed Joint Tenants

Your Children and Ages

Present Employer and Contact Details*

Current Salary

Previous Employer and Contact Details

Parent Details (for Students Only)

Guarantor Contact Details

Declaration of Criminal Record*

	I have NO criminal convictions.
	I have criminal convictions.

Details of Convictions if Any

Statement by Applicant*

I hereby acknowledge and agree that:

1. The information I have given in this application is true and complete.
2. I have to pay a deposit before a tenancy can commence.
3. My current and previous landlords and employers, credit referencing agencies may be contacted for references.
4. Information about this application (and the tenancy, if granted) may be recorded on computerand be used for reference purposes in the future.
5. I must produce evidence of my income before my application may be considered.
6. I must provide two written references before my application may be considered.

I further understand that:

Section 102 Housing Act 1996 allows a Landlord to seek possession under ground 17 in Part II od Schedule 2 where he/she has been induced to grant a tenancy by a false statement made knowingly or recklessly by (a) the tenant, or (b) a person acting at the tenant's instigation.

On-line Signature Acknowledgement*

I acknowledge that by clicking the radio button on the left I am the named applicant on this form and by typing my name in the field adjacent to "On-line Signature" I am subsituting it for my signature.

On-line Signature *

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