A.AGENT DETAILS Breakfast Point Realty Address: 8 Magnolia Drive, Breakfast Point NSW 2137 Phone Number: (02) 8765 9800 Fax Number: (02) 8765 9822 Email: alison@breakfastpointrealty.com.au Web: www.breakfastpointrealty.com.au B.PROPERTY DETAILS 1. What is the address of the property you would like to rent? * 2. Lease commencement date? * Days Months Years 3. Lease Term? * Years Months 4. How many tenants will occupy the property? * Adult Children Request for Country Club Access with tenancy * Yes No C. PERSONAL DETAILS 5. Please give us your details * Mr Ms Miss Mrs Other Surname * Given Name/s * Date Of Birth * Australian Driver's licence No * Driver's licence Expiry Date * Driver's licence State * Passport No (if applicable) * Passport Country * Pension No. (if applicable) Pension type (if applicable) 6. Please provide your contact details Home Phone No. * Mobile Phone No. * Work Phone No. * Fax No. * Email Address * 8. What is your current address? * Postcode * HOW DID YOU FIND OUT ABOUT THIS PROPERTY? * Newspaper The Internet Local Paper Office Office Window Sign Board at Property Referral Other (specify) D. UTILITY CONNECTIONS This is a free service that connects all your utilities Once we have received this application we will call you to confirm your details. Direct Connect will make all reasonable efforts to contact you within 24 hours of the nearest working day on receipt of this Application to confirm the information on this Application and explain the details of the services offered. Direct Connect is a utility one stop connection service. Please tick utilities as required * Electricity Gas Phone Pay TV Internet       *The Property is: New, or Vacant for 1 month or more DECLARATION AND EXECUTION: By signing this application, I/we: consent to Direct Connect arranging for the connection and disconnection of the nominated utility services and to providing information contained in this application to utility providers for this purpose; acknowledge having been provided with terms and Conditions of Supply of Direct Connect and having read and understood them together with the Privacy Collection Notice set out above; declare that all the information contained in this application is true and correct and given of their own free will; expressly authorise Direct Connect to provide any information disclosed in this Application to a supplier or potential supplier of the Services in accordance with the Privacy Collection Notice and to obtain any information necessary in relation to the Services; expressly authorise Direct Connect to provide any information disclosed in this Application to an information provider for the purpose of that information provider disclosing it to a supplier or potential supplier of the Services in accordance with the Privacy Collection Notice and to obtain any information necessary in relation to the Services; understand that under the requirements of the Privacy Act 1988, Direct Connect will ensure that all personal information obtained about me/us will be appropriately collected, used, disclosed and transferred and will be stored safely and protected against loss, unauthorised access, use, modification or disclosure and any other misuse; authorise the obtaining of a National Metering Identifier (NMI) for my residential address to obtain supply details; consent to Direct Connect disclosing my/our details to utility providers (including my/our NMI and telephone number); declare and undertake to be solely responsible for all amounts payable in relation to the connections and/or supply of the Services and hereby indemnify Direct Connect and its officers, servants and agents and hold them indemnified against any charges whatsoever in respect of the Services; acknowledge that, to the extent permitted by law, Direct Connect shall not be liable for any loss or damage (including consequential loss and loss of profits) to me/us or any other person or any property as a result of the provision of the services or any act or omission by the utility provider or for any loss caused by or in connection with any delay in connection, disconnection or provision of, or failure to connect or disconnect or provide, the nominated utilities; acknowledge that whilst Direct Connect is a free service I/we may be required to pay standard connection fees or deposits required by various utility providers; acknowledge that the Services will be provided according to the applicable regulations and that the time frames and terms and conditions of the nominated utility providers bind me/us and that after hours connections may incur additional service fees from utility providers; acknowledge that the real estate agent listed on this application form may receive a benefit from Direct Connect in connection with the provision of the service being provided to me/us by Direct Connect; and acknowledge the entitlement of Direct Connect and its associates, agents and contractors, to receive a fee or remuneration from the utility provider and that such fee or remuneration will not be refunded to me as a rebate in connection with the provision of the utility connection services. I acknowledge that i have read and understood the above* Yes No E. DECLARATION I hereby offer to rent the property from the owner under a lease to be prepared by the Agent. Should this application be accepted by the landlord I agree to enter Into a Residential Tenancy Agreement. I acknowledge that this application is subject to the approval of the owner/landlord. I declare that all information contained in this application (including the reverse side) is true and correct and given of my own free will. I declare that I have Inspected the premises and am not bankrupt. I authorise the Agent to obtain personal Information from: (a) The owner or the Agent of my current or previous residence; (b) My personal referees and employer/s; (c) Any record listing or database of defaults by tenants; If I default under a rental agreement, I agree that the Agent may disclose details of any such default to a tenancy default database, and to agents/landlords of properties I may apply for in the future. I am aware that the Agent will use and disclose my personal information in order to: (a) communicate with the owner and select a tenant (b) prepare lease/tenancy documents (c) allow tradespeople or equivalent organisations to contact me (d) lodge/claim/transfer to/from a Bond Authority (e) refer to Tribunals/Courts & Statutory Authorities (where applicable) (f) refer to collection agents/lawyers (where applicable) (g) complete a credit check with NTD (National Tenancies Database) I am aware that if information is not provided or I do not consent to the uses to which personal information is put. the Agent cannot provide me with the lease/tenancy of the premises. I am aware that I may access personal information on the contact details above. I acknowledge that i will pay a full telephone connection fee of between $299.00 if required. I the applicant so solemnly and sincerely declare that I am not bankrupt or an undercharged bankrupt and affirm that the above information is true and correct.* Yes No F. APPLICANT HISTORY 9. How long have you lived at your current address? Years Months 10. Why are you leaving this address? 11.Landlord/Agent details of this property (if applicable) Name of landlord or agent Landlord/agent's phone no. Weekly rent paid ($) 12. What was your previous residential address? Postcode 13. How long did you live at this address? Years Months 14. Landlord/Agent details of this property (if applicable) Name of landlord or agent Weekly rent paid Landlord/agent's phone no. Was bond refunded in full? If not why not? G. EMPLOYMENT HISTORY 15. Please provide your employment details What is your occupation? What is the nature of your employment? (FULL TIME/PART TIME/CASUAL) Employer's Name (inc. accountant if self employed or institution if a student) Employer's address Postcode Contact Name Phone no. Length of employment Years Months Net Income? 16. Please provide your previous employment details Occupation? Employer's name: Length of employment Years Months Net Income? H. CONTACT / REFERENCES 17. Please provide a contact in case of emergency Surname Given name/s Relationship to you Phone no. 18. Please provide two personal references (not related to you) 1. Full Name Relationship to you Phone no. 2. Full Name Relationship to you Phone no. I. OTHER INFORMATION 19. Car Registration 20. Please provide details of any pets: Breed / type Council registration / number 1. 2. J. PAYMENT DETAILS Property Rental per week per month     Rental Bond (4 weeks rent): First payment of rent in advance: Tenants share of cost of preparing tenancy aggreement: Sub Total Less: deduct Reservations Fee (see below) Amount payable on signing tenancy agreement (bank cheque or money order only) K. RESERVATION Complete this section if you wish to reserve the property for a period of time: Reservation Fee Reservation Period days

The Landlords Agent undertakes: a) The premises will not be let during the Reservation Period, pending the agreement of a residential tenancy agreement: b) The whole fee will be refunded if the Landlord does not decide to enter into a residential tenancy agreement for the premises for the Reservation Period: c) The whole fee will be refunded if the Landlord does not carry out (during the Reservation Period) repairs or other work on which it is a condition to enter into a residential tenancy agreement: d) If the applicant decides not to enter into a residential tenancy agreement, and the premises are not let or otherwise occupied during the Reservation Period, the Landlord may retain the portion of the fee representing the rent that would have been paid during the Reservation Period (based upon the proposed rent), but must refund the remainder: e) If a residential tenancy agreement is entered into, the fee is to be contributed towards rent for the premises.

I acknowledge that i have read and understood this privacy statement.

Yes No