Bloomingdale Residential

Property Rental Address:

Total Monthly Rent : (£)

If a joint tenancy, please state the applicant's share : (£)

pcm

Is the individual a prospective Tenant

or Guarantor* (please tick)

*If a guarantor, please also provide the applicant(s) they are acting for

Name of Applicants:

Individual Details

Title:

First Name(s):

Surname:

Date of Birth:

Marital Status:

Married Separated Divorced Widowed

Current Address :

Tel :

Mobile :

Email:

Owner :

Council Tenant Private Tenant With Parents Home Owner Other (please advise)

Post Code :

Period at address :

Reason for departure :

Where you have been leaving during the last three years?

If less than three years at the current address, please provide previous addresses and dates of occupation;

Address:

Period at address:

Address:

Period at address:

Address:

Period at address:

Have you any current, historic or pending adverse credit? If yes, please supply the details

Estate/Letting Agent, Solicitor or Landlord regarding where you are now living

Company or Landlord name:

Address:

Post Code:

Tel (Day):

Tel (Eve):

Current Income Details

Employed : Self Employed On Contract Temporary Retired Student

Company or Landlord name:

Address:

Post Code:

Gross salary/pension per annum : (£)

Position held:

Commencement date:

Payroll, Service or Pension number :

Tel:

Fax:

Full time Part time

Is this permanent?: Yes No

If not permanent, please provide the work end date :

Is your employment to change in the near future?: Yes No

If yes, please provide details;

Previous Employment Details

Where have you been working during the past three years? Please provide details of previous employers, along with commencement and departure dates, attaching a separate sheet if necessary

Company or Landlord name:

Address:

Post Code:

Tel:

Fax:

Commencement date :

Departure date :

Accountant / Auditor details if self employed / retired

Please authorise your accountant/auditor to provide a reference

Bank/Building Society Name:

Address:

Account Name:

Tel:

Account Name:

Sort Code:

Personal Reference

Name:

Address:

Post Code:

Tel:

Fax:

Next of Kin excluding spouse

Name:

Address:

Post Code:

Tel:

Fax:

Additional occupants & general occupants & general information

Please list the names of all prospective tenants over 18 years of age to reside at the address

Ages of children:

Smokers/non Smokers:

Nationality:

List any Pets:

Declaration

Once the application form has been fully completed, please submit to your agent

I confirm that the supplied information is to the best of my knowledge and belief, true, and may be verified. I understand that should the information provided by me on this form prove to be untrue, it is grounds for termination of the tenancy as described in Ground 17 of the Housing Act 1996. DATA PROTECTION ACT: information provided by you on this form may be verified and held by Bloomingdale Residential in its computer records. I confirm that the progress of this application may be made available to agents, landlords and co-applicants. I also hereby authorise the above named Bank or Building Society to respond to status enquiries made in respect of this application. Bloomingdale Residential may search the file of a credit reference agency. Any information obtained or compiled by Bloomingdale Residential may be passed on to Agents and Landlords.