InfinityGates · Residential Tenancies Act 1997 Section 30AC

Residential rental application

311/44 Brunswick St, Fitzroy, VIC, 3065

This form is for applications to enter into a residential rental agreement, not social housing or specialised housing programs. Each applicant aged 18 or over may be asked to complete a separate application. For your rights and responsibilities, visit Consumer Affairs Victoria or call 1300 55 81 81.

Original form & rights information

Part A — General · 1 Premises

311/44 Brunswick St, Fitzroy, VIC, 3065

2 Rental provider or agent’s details

Name: InfinityGates
ACN / ABN: Not supplied — contact the agent
Address: 8 Sirius Way, Officer VIC 3809
Phone: 0405681427
Email: Rental@infinitygatesrealty.com.au
Provider’s state / territory: Not supplied — contact the agent

3 Number of occupants

Total intended occupants *

4 Personal details of applicant

Full name *Date of birth *Current address *Postcode *Phone *Email *

5 Employment details

Current or most recent employerEmployer addressNet weekly income ($)If not employed, most recent employment ended

If you cannot provide employment or income details, provide other details of your ability to pay rent in item 6.

6 Financial information

The agent may request no more than two financial documents. Bank statements must not include transaction details. Discuss alternative documentation if you cannot supply a requested document.

No financial documents have been requested by the agent.

Other details of your ability to pay rent

PDF, JPG or PNG · Maximum 2 MB per file

7 Verification of identity

No more than two identity documents may be requested. Contact the agent about alternative verification if needed.

No identity documents have been requested by the agent.

8 Rental or residential history

Property 1 — Current / most recent

AddressPostcodePeriod of residence (start and end dates)Rental provider / agent name (if applicable)Provider / agent email (if applicable)Provider / agent phone (if applicable)

Property 2 — Previous

AddressPostcodePeriod of residence (start and end dates)Rental provider / agent name (if applicable)Provider / agent email (if applicable)Provider / agent phone (if applicable)

9 References

Personal referee details may be provided if requested by the rental provider or agent.

Referee 1

NamePhoneEmailConnection to applicant

Referee 2

NamePhoneEmailConnection to applicant

10 Term of rental agreement

Desired lease term *Preferred move in date *

11 Tenancy databases

If a tenancy database is used, the agent must disclose it here and provide the notices required by section 439D(2) of the Act.

No tenancy databases have been disclosed by the agent.

Part B — Rights and obligations

No application fees are payable. Rental auctions and bidding above the advertised fixed rent are prohibited. The agent must only request information permitted in this application form.

Personal information is collected only to assess this rental application. It is confidential and accessible only to authorised staff. Contact the rental provider or agent about access, corrections or alternative documentation.

Applicants should contact the agent to check the outcome and may discuss alternative documentation. The original form above contains the full rights, obligations and interpreter information.

If successful, information must be destroyed or permanently de-identified within three years after the rental agreement ends. If unsuccessful, it must be destroyed or permanently de-identified within 30 days after the property is leased, or within six months where written consent has been given to use it for other premises.

12 Signature

I understand that my application may not be processed unless all required documents are submitted.

Print name *Signature (type full name) *Date *

I confirm the information is true and correct, have read the rights and privacy information, and agree that my typed name is my electronic signature for this application.