Rental Application


Room & Address of Premises: 

Rent per week:

Applicant Details:


License or Passport No (plus VISA expiry date):

Nationality:Main language:

Current address:

Address in home country (if applicable):

Mobile:Home country phone (if applicable):

Email address:

How long have you been at current address:

Reason for leaving:

Current landlord:Contact number:

Are you currently employed:Length of employment:

Name of Employer:Employer contact:

Basis (Full time, Part Time, Casual):Weekly salary:

Are you currently studying:Name of school:

Course studying:

Referee 1:Contact:

Referee 2:Contact:

Contact inAustralia(Friend or Relative):

Name:   Contact:


I authorise Shared Living SA to contact any person listed on this form for the purpose of verifying the 

information provided and obtaining a reference. I declare that all the information I have provided on this

application to be true and correct.



Print Name:Date:

Note: Please include a copy of a Passport and/or Australian Driver's License

  Verification Code:
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