PRIVACY ACT 1993 STATEMENT

Cautions and Information drawn to your attention in terms of the Privacy Act 1993 before you complete the application form on the reverse.

  • This information is being collected by the landlord / Landlord's agent.
  • This application collects personal information about you.
  • This information is required to assess your eligibility as a tenant.
  • If you fail to provide any of the information requested on this form you may not be considered as a tenant for any of the properties we administer.
  • This information is required to assess whether you are a minor and able to enter this contract with the approval of the Tenancy tribunal.

This information is required to; collect information which will be loaded onto Nationwide Tenant Placement, rent default, damages computer database. (A tenant placement and default database records the names of all tenants in rental accommodation. Those people who have been found to breach their Residential Tenancy Agreement Act 1986 by the Tenancy tribunal). A Tenant Placement Database records your previous history of Residential / Commercial accommodation, your rent payment history, comments on the condition of the property interior and exterior and any damage caused during occupation.

I agree that you may use any of the information on this form to enforce any judgement in respect of the tenancy agreement or in respect of any order against me made by the Tenancy Tribunal.

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The details on this form are required, by the landlord (for New Zealand Tenancy Information Services Ltd) for management and administration purposes. A separate form is required for each signatory to any Tenancy Agreement. I grant authority to New Zealand Tenancy Information Services Ltd, the landlord or Real Estate Agents under provisions of the Privacy Act 1993 principals 2(2) (b) 3 (4) (a) 10 (b) & 11 (d), to collect, disclose, give, use & to make inquiries into any individual on this form & into any information on this form and on any matter relating to any tenancy relevant to myself. I agree that this authority is irrevocable.

Tenant's Declarations, Waivers and Authorities contained in a Tenancy Application form.

  1. I declare that the information given above is correct and that the landlord may check on any of the details.
  2. I agree to any of this information being given to another landlord.
  3. I agree that the landlord can obtain other information about me.
  4. I agree that the landlord may use any of the information on this form to enforce any judgement or money order obtained against me.
  5. I authorise the landlord to obtain information about me from the Tenant Default Database or Debt Collection Bureaux or landlord, Real Estate firm, or Power Supply Company, or gas Company or any Telecommunication Company, either Telecom or Clear.

I acknowledge that the information may then be publicly accessible through the Nationwide Tenant Placement, Rent, Damage, Default Database.

I consent to you providing the information in this form and details of any proven breach of my Residential / Commercial Tenancy Agreement or of the Residential Tenancies Act 1986 to New Zealand Tenancy Information Service Ltd, to debt collection agencies, Power supply company, Gas supply Company, Income Support, Postal Authority, Telecom, Clear phone supply company, Hire purchase.

  • You have a right to see the information held about you by any Tenant Default Database, Debt Collection Bureaux and to correct it in accordance with the Privacy Act.
  • You have the right to see the information we hold about you and to correct that information in accordance with the privacy Act;

I, the person named on the "Tenants Details" on the reverse declare that the above information about my right sunder the Privacy Act 1993 was brought to my attention before I completed the Application for Tenancy form.

I declare that this authority cannot be subsequently cancelled by me.