LOCAL LETTINGS

Midland House, 77 Huddersfield Road, Mirfield, WF14 Tel" #1$%4 &#1''' Fa(" #1$%4 &#11)) !L

*RO*ERT+ A**LIE, FOR

Rental Address: Postcode Total rent: Total rent per Applicant: Is this a Joint Tenancy Application: per calendar month per calendar month Yes No eans "ousing #enefit

Are you to pay the rent through your own means or housing benefit: Names of other occupants o$er the age of %& years: Names and dates of birth of all children who will reside at the property: Proposed Tenancy 'ommencement (ate: )ength of Tenancy:

Own

Years

onths

A--li.an/s 0ill 1e 2oin/l3 and se4erall3 lia1le for /5e /o/al ren/ -er 6on/5 for /5e -ro-er/3

A**LICANT ,ETAILS
Title: arital ,tatus: /irst name*s+: aiden Name: "ome Telephone No: 1mail Address: 'urrent Address: r rs s Other Other
*please specify+

arried - ,ingle - (i$orced - ,eparated - .idowed

*please specify+

,urname: (0O0#0 obile:

,tatus at current address:

! !

Tenant *pri$ate+ Tenant *council+

! !

Owner

Time at address:
Years onths

)i$ing with friends-family

Pre$ious address:

*If less than 2 years at current address+:

,tatus at pre$ious address:

! !

Tenant *pri$ate+ Tenant *council+

! !

Owner

Time at address:
Years onths

)i$ing with friends-family

*lease -ro4ide -re4ious addresses and da/es of residen.3 for /5e las/ ' 3ears
7-lease a//a.5 a se-ara/e s5ee/ if re8uired9

A**LICANT EM*LO+MENT ,ETAILS

1mployed ,tatus: /ull time Part time Permanent 'ontract Temporary 'ontract ,elf3employed Not employed Retired

Job Title: 1mployer4s-Accountant4s name and address: National Insurance No: 1mail contact for employer reference: Telephone Number for employer reference: 'ontact name and position: Payroll No: /a5 number for employer reference: Your wor6 telephone number: 7ross monthly salary:
If less than 9 months: please supply pre$ious employer details: including time in employment in additional details section

Time in 8ob: Years onths

Are you aware of any matters that may cause your employment to change in the near future ; *If Y1,: please gi$e details on a separate sheet+

Yes !

No !

S*O:SE EM*LO+MENT ,ETAILS

1mployed ,tatus: /ull time Job Title: 1mployer4s-Accountant4s name and address: National Insurance No: 1mail contact for employer reference: Telephone Number for employer reference: 'ontact name and position: Time in 8ob: Years onths Payroll No: /a5 number for employer reference: Your wor6 telephone number: 7ross monthly salary:
If less than 9 months: please supply pre$ious employer details: including time in employment in additional details section

,elf3employed Part time

Not employed 'asual

Retired Temporary

Are you aware of any matters that may cause your employment to change in the near future ; *If Y1,: please gi$e details on a separate sheet+

Yes !

No !

If self;e6-lo3ed, -lease -ro4ide ' 3ears of a..oun/s *AST EM*LO+MENT ,ETAILS

If 3ou 5a4e 1een in 3our .urren/ e6-lo36en/ for less /5an 1% 6on/5s -lease -ro4ide de/ails of -re4ious e6-lo36en/ in.ludin< .o66en.e6en/ and lea4in< da/es 7-lease a//a.5 a se-ara/e s5ee/ if re8uired9

,O +O: HA=E AN+ A,,ITIONAL SO:RCE OF INCOME> ; *roof 6us/ 1e -ro4ided

Pension: Other: < < In$estment Income: Please specify: <

E?ISTING@*RE=IO:S LETTING AGENT@LAN,LOR, if a--li.a1le

7*lease <i4e au/5ori/3 /o 3our A<en/ /o -ass an o-inion on 3ou9

'ompany-Indi$idual Name:

Address:

1mail address for rent reference: Telephone Number: Pre$ious rent paid: Reason for tenancy-mortgage ending: < /a5 Number: per calendar month

FINANCIAL HISTOR+
Are you aware of any pre$ious ''Js-#an6ruptcy; If Y1,: please gi$e details below: Y1, NO

!ANA ,ETAILS
Name and address of ban6:

#ranch sort code: Account number: Account name:

(o you ha$e a 'redit 'ard;

Yes !

No !

If Y1,: for how long;

*lease -ro4ide de/ails of -re4ious 1anB@1uildin< so.ie/3 of .urren/ one is for less /5an ' 3ears

GENERAL INFORMATION
(o any of the named applicants or proposed Tenants for this property ha$e any pets if Y1, what type: (o any of the named applicants or proposed Tenants for this property smo6e; Are you a $ehicle owner; =ehicle Registration No:

! Yes ! Yes

! No ! No

! Yes

! No
(ri$ers )icence No:

NE?T OF AIN
Name: Address: Postcode Tel:

A,,ITIONAL ,ETAILS
Please add any additional details you feel are rele$ant to support your application:

S:!MISSION REC:IREMENTS
In order to process your reference efficiently we re>uire the following: If e6-lo3ed" If ,SS" If self;e6-lo3ed" ! Your two most recent pay slips if paid monthly *four if paid wee6ly+

! 'opy of local housing rates ! Your last 2 years accounts OR ! Accountants-Auditors details

IN ALL CASES D If no/ on /5e ele./oral roll -lease -ro4ide

-roof of address for /5e -as/ ' 3ears 7iEeE, u/ili/3 1ill@-5one 1ill@ 1anB s/a/e6en/9 D Co-3 of dri4in< li.en.e@-ass-or/

I hereby authorise )ocal )ettings and 1states to ma6e any en>uiries considered necessary to substantiate information supplied on this application0 I authorise )ocal )ettings and 1states to disclose any information about me and my account to any credit reference agency and-or any other tenancy database who may retain a record of such a search0 This information is used to help me ma6e credit: insurance: rental and property decisions and occasionally for fraud pre$ention or debtor tracing0 I gi$e my permission to ta6e up all necessary references and that these may be shown to a )andlord and-or their lender0 I confirm that the information supplied is: to the best of my 6nowledge and belief: true0 ,ignature of Applicant*s+ (ate

,ignature of Applicant*s+

(ate