Reference Form

Please complete the details below to proceed with your tenancy application.

REFERENCE FORM

1192A STRATFORD ROAD, BIRMINGHAM, B28 8AB

TEL: 0121 777 3386 | EMAIL: INFO@EZ-HOMES.CO.UK

1. Details of property applying Tenancy for

Property Address *

Postcode *

Tenancy Start Date *

Deposit (£) *

Rent Agreed (PCM £) *

Furnished?

2. Occupancy & Citizenship

How many Adults including yourself (18 and over)? *

Are you a British Citizen? *

3. APPLICANT DETAILS (FOR ALL ADULTS)

Adult 1

Title

First Name *

Surname *

Other Name(s)

Date of Birth *

Telephone

Mobile *

Email *

Have you any County Court Judgements, Court Decrees, Bankruptcy, or Administration orders? *

Are you contributing towards the rent? *

Comment / Offer

4. PREVIOUS/ CURRENT ADDRESS OF THE PRIMARY APPLICANT

Address *

Postcode *

5. CURRENT LANDLORD OR AGENT (If applicable)

Name of Landlord or Agent

Address

Postcode

Telephone (Evening)

Fax

6. APPLICANT'S EMPLOYMENT STATUS

Status *

Details of current Employer/Pension Administrator/Accountant

Company Name

Contact Name

Telephone

Address

Postcode

Position Held

Is this position permanent?

Annual Gross Income (£)

Start Date

Do you require a Guarantor?

I would like to offer higher deposit (£)

7. Useful Information

Personal Details *

Are you a smoker? *

Do you have any pets? *

Do you have any Children? *

Name of next of Kin (Other than your spouse)

Name *

Telephone *

Relationship *

Address *

Postcode *

8. REQUIRED DOCUMENTS

Passport(s) *

Salary Slips (Last 2 Months) *

Bank Statements (Last 2 Months) *

9. DECLARATION

Please read the declaration and sign and date below. WE CANNOT PROCEED WITH THIS APPLICATION IF YOU DONT SIGN.

I hereby confirm that the information provided by me is to the best of my knowledge true. I consent to this information being verified by contracting the third parties Agency and IDS Ltd, the insurance industry's data collection agency, which will keep a record of that search. I understand that i may request the name and address of the Credit Reference Agency to whom I may then apply for a copy of the information provided.

I also understand that in the event of my defaulting on the rental payment, that any such default may be recorded with the Credit Referencing Agency and IDS Ltd, who may supply the information to other credit companies or insurers in the quest of the responsible granting of tenancies, insurance and credit.

I understand that in the event of any default by me in respect of the covenants in my tenancy agreement with my landlord, the information contained herein may be disclosed to EZ Homes and/or one or more tracing companies and/or debt collection agencies in order to recover any monies due or to trace my whereabouts. I understand that the information provided by me may be transfered to a country outside of the EU for the purposes only of processing this referencing application, notwithstanding such transfer, EZ Homes will remain the Data Controller for the purposes of this application. The information provided in this form by me is information as decribed in Ground 17 of the Housing Act 1996 and I understand that if any information within this application is found untrue, it is grounds for termination of the tenancy.

Applicant Signature(s) *

Date *