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Tenancy Application

First Name

Email

Last Name

Day Phone

Evening Phone

Current Address

Are you receving support from a service provider?

Yes

No

If yes, please give details

What is the name of your health serivce provider?

What is the name of your key/support worker?

Their contact number

Are you a New Zealand resident?

Yes

No

Your source of income: if beneficiary, what type of benefit?

I agree to have my rent paid directly from my WINZ benefit

Yes

No

If employed- name of employer, address and contact number

Annual income

Your accomodation requirements- Number of adults

Number of children

Suburb preference (if any)

Are you willing to share a 2-bedroom unit?

Yes

No

Do you smoke?

Yes

No

Referees:

Please provide at least 2 referees/references from the following: your whanau, mental health/social services team or a current or previous landlord

Referee 1 - a member of your whanau

Their relationship to you:

Their contact number

Referee 2 - Mental health/social services team

Their contact number

Referee 3 - Current of previous landlord

Their contact number:

When your application has been approved we may contact you for an interview. Tell us about why you require accomodation:

Any other information you may want us to consider?

This information may be used solely to obtain personal references or to obtain further information to clarify statements made above.

I Agree

Your Name

Date

THANK YOU FOR YOUR APPLICATION!!!

KAINGA

KO WAI MATOU

Our Whakapapa

NGA RATONGA

HOTAKA

TE KOTUKU KI TE RANGI

Hakinakina

Residential Services

The Board

Nga Kaimahi

Whanau Engagement

Community Support

Self Referral

Mauri Tau

2/40 Copsey Business Park,

Copsey Place, Avondale

Auckland, New Zealand 1026

PO Box 71-129 Rosebank

Auckland 1026

He Panui

Staff Professional Development

SOCIAL HOUSING

PUREITANGA

CAREERS

09 820 0045

0800 731 188

TE WHAKAPA

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Tenancy Application

Referees:

​

Please provide at least 2 referees/references from the following: your whanau, mental health/social services team or a current or previous landlord

KO WAI MATOU

TE KOTUKU KI TE RANGI

2/40 Copsey Business Park,

Copsey Place, Avondale

Auckland, New Zealand 1026

​

PO Box 71-129 Rosebank

Auckland 1026

09 820 0045

0800 731 188