PROPERTY: _______________________________________________ DATE: ____________________________ APPLICANT ONE Title: Mr Miss Mrs Ms Other __________
APPLICANT TWO Title: Mr Miss Mrs Ms Other __________
Forenames: _____________________________________ Forenames: ____________________________________ Surname: ______________________________________
Surname: ______________________________________
Any previous surnames: __________________________
Any previous surnames: __________________________
Date of Birth: ___________________________________ Date of Birth: __________________________________ Contact numbers:
Contact numbers:
Home: ________________________________________
Home: ________________________________________
Work: ________________________________________
Work: ________________________________________
Mobile: _______________________________________
Mobile: _______________________________________
E-mail: _______________________________________
E-mail: _______________________________________
Marital status: _________________________________
Marital status: _________________________________
Number of dependents: ___________________________
Number of dependents: ___________________________
Ages: _________________________________________ Ages: ________________________________________ Name: ____________________ D.O.B. ______________ Name: ___________________ D.O.B. ______________ Name: ____________________ D.O.B. ______________ Name: ___________________ D.O.B. ______________ Name: ____________________ D.O.B. ______________ Name: ___________________ D.O.B. ______________ Affordability Details
N.I. Number ____________________________________ N.I. Number ____________________________________ Occupation: ____________________________________ Occupation: ____________________________________ Employer: _____________________________________
Employer: _____________________________________
Employment type:
Employment type:
Full time Part time Temporary/contract
Full time Part time Temporary/contract
Self employed Unemployed Student
Self employed Unemployed Student
Housewife/homemaker
Housewife/homemaker
Gross annual income: £___________________________
Gross annual income: £___________________________
Additional income? : Yes No
Additional income? : Yes No
Jobseekers £_________________________________
Jobseekers £_________________________________
Income Support £_____________________________
Income Support £_____________________________
Child Tax Credits £___________________________
Child Tax Credits £___________________________
Working Tax Credits £_________________________
Working Tax Credits £_________________________
Child Benefit £_______________________________
Child Benefit £_______________________________
Housing Benefit £_____________________________
Housing Benefit £_____________________________
Child Support £_______________________________
Child Support £_______________________________
Other (please state) £___________________________
Other (please state) £___________________________
Bank Details Credit cards: Yes No How many?
Credit cards: Yes No How many?
Current Account: Yes No
Current Account: Yes No
Cheque guarantee card: Yes No
Cheque guarantee card: Yes No
Bank: _________________________________________ Bank: _________________________________________ Address _______________________________________
Address _______________________________________
______________________________________________
______________________________________________
Account name: _________________________________
Account name: _________________________________
Account number: ________________________________ Account number: ________________________________ Sort code: ______________________________________ Sort code: ______________________________________ Time with bank: Years _________ Months ___________
Time with bank: Years _________ Months ___________
Please supply addresses to cover your last three years of residency. Current address: please complete all address details where appropriate. Current Landlord/Agent:
Current Landlord/Agent:
Name & Address: _______________________________ Name & Address: _______________________________ _____________________________________________
_____________________________________________
Current Address:
Current Address:
No:________Street: _____________________________
No:________Street: ______________________________
Town: ________________________________________
Town: ________________________________________
District: _______________________________________ District: _______________________________________ County: _______________________________________ County: _______________________________________ Postcode: ______________________________________ Postcode: ______________________________________ Time at this address
Time at this address
From: month _______________ year _______________ From: month _______________ year _______________ To:
month _______________ year _______________ To:
month _______________ year _______________
Previous address: please complete all address details where appropriate.
No:________Street: ______________________________ No:________Street: ______________________________ Town: ________________________________________
Town: ________________________________________
District: _______________________________________
District: _______________________________________
County: _______________________________________
County: _______________________________________
Postcode: ______________________________________ Postcode: ______________________________________ Time at this address
Time at this address
From: month _______________ year _______________
From: month _______________ year _______________
To:
To:
month _______________ year _______________
month _______________ year _______________
Additional Information Pets?: Yes No Number ______________________
Pets?: Yes No Number ______________________
Smoker? Yes No
Smoker? Yes No
Next of Kin ____________________________________
Next of Kin __________________________________
Address _______________________________________
Address _____________________________________
______________________________________________
____________________________________________
Telephone _____________________________________
Telephone ___________________________________
E-mail ________________________________________
E-mail ______________________________________
References (must not be a family member)
Name: ________________________________________
Name: ________________________________________
Address: _______________________________________ Address: _______________________________________ ______________________________________________
______________________________________________
Postcode: ______________________________________ Postcode: ______________________________________ Telephone: _____________________________________ Telephone: _____________________________________ E-mail/fax: _____________________________________ E-mail/fax: _____________________________________ Occupation: ____________________________________ Occupation: ____________________________________
Consent We will use the information provided to us by third parties to make decisions about your application. Agencies may supply to us, public information and/or fraud prevention information. Information provided by Endsleigh may be supplied to other organizations and used by them and us to: Verify your identity for this application and if you apply for other facilities including all types of insurance applications and claims. Check all or any of the application details which have been submitted Assist organizations to make decisions on tenancy applications by you By confirming your agreement to proceed you are accepting that we my use your information in this way. Endsleigh* offer specialist contents insurance for people of rented accommodation and as a service will contact the applicant to discuss insurance requirements. If you do not wish to be contacted please tick here The information contained within this application is being transmitted to and is only for the use of Experian. If the reader of this message is not the intended recipient, you are hereby advised that any dissemination, distribution or copy of this application is strictly prohibited. If you receive this application in error, please immediately notify us by calling *Endsleigh Insurance Services Limited is authorized and regulated by the Financial Services Authority. This can be checked on the FSA Register by visiting its website at www.fsa.gov.uk/register. Endsleigh Insurance Services Limited. Company No 856706 registered in England at Shurdington Road, Cheltenham Spa, Gloucestershire GL51 4UE
Sign Name: ____________________________________ Sign Name: ____________________________________ Print Name: ____________________________________ Print Name: ____________________________________ Date: _________________________________________
Date: _________________________________________
Please return to:- PMC Rentals & Management, 22 New Row, Coleraine, County Londonderry, BT52 1AF Telephone: 028 7032 2575 E-mail:
[email protected]
ADDITIONAL INFORMATION (please use separate sheet if needed):
