Residential Application Form

Residential Application Form

This form should be completed separately for each tenant over the age of 18 years old.
Property details of rental
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Tenancy start date*

MonthDayYear
Date
Length of tenancy*
(In months)
Number of persons who will occupy the property*
Personal details
Applicant's Name*

TitleFirst NameLast Name
Previous Full Name
Number of applicants*
Date of Birth*

MonthDayYear
Date
Marital status*
Number of children*
NI Number*
Nationality*
Passport number*
Phone Number*

Area CodePhone Number
Email*
example@example.com
Please state the names of the other occupants and relationship to the applicant.
Are there any aspects of your background or any medical condition that you would like us to be aware of?
Emergency contact name*

First NameLast Name
Mobile number for emergency contact*
Please enter a valid phone number.
YesNo
Occupation/Job Title? *
Name of Company*
Department
Employment commencement*

MonthDayYear
Date
Is your employment temporary or permanent?*
Name of line manager*

First NameLast Name
Email address of line manager*
example@example.com
Phone number of line manager*
Please enter a valid phone number.
What is your monthly gross income? (£) *
What is your annual gross income? (£)*
Please upload Proof of Income within the last 3 months*

Cancelof
Bank details*
Do you receive any benefits? If yes, please specify:*
YesNo
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Duration of Occupancy*
Reason(s) of leaving*
Current Landlord Name*

First NameLast Name
Current Landlord Phone Number*

Area CodePhone Number
YesNo
If yes, please explain below:
YesNo
If yes, please explain below:
Requested move in date*

MonthDayYear
Date
Date to pay the security deposit*

MonthDayYear
Date
CashCredit CardBank PaymentOther
Applicant's Signature

Powered by Jotform SignClear
Date Signed*

MonthDayYear
Date

Agreement to Pay Deposit
In consideration of Direct Housing Ltd considering my application for a tenancy agreement on the property known as: Street Address* Postcode* I, First Name* Last Name* agree to pay to Direct Housing Ltd the sum of £ Deposit amount* to reserve the property. This payment is to be held in a separate client account on the following terms;
1. If my application is not acceptable to Direct Housing Ltd, the full holding deposit will be refunded to
me.
2. I agree to ensure all paperwork for myself, and the rest of my group where applicable, will be
completed within 7 days of the first holding deposit being placed. I understand failure to complete
all paperwork, up to and including signing of the tenancy agreement, will result in the property
being re-advertised and the holding deposit being withheld.
3. From the tenancy commencement date I understand my holding deposit will be held on the terms
as specified in the tenancy agreement as a dilapidations deposit.
4. On the day on which the tenancy agreement ends or is surrendered, the account shall be closed
and the sum contained will be applied in payment to any outstanding rent or any amount due to
the landlord as a result in any breach of the terms of the agreement with the landlord made by me
or my group. These deductions include any payment due in respect of dilapidations to the
premises, i.e. damages, breakages, hire of professional cleaning and laundry costs, and any
outstanding utility account bills, and local property tax charges.
5. Tenants requiring a student visa would need to pay all rent in advance unless a UK based guarantor
can be provided.
I acknowledge my rent will be £ rent amount per month* per calendar month and agree to pay this amount on the date it becomes due.
Please note:
Any holding deposits placed on properties which are managed or are to be managed by Direct Housing Ltd
will be registered with the TDS (Tenancy Deposit Scheme) upon commencement of tenancy. Our admin
team will provide you with a deposit certificate.
Any holding deposits placed on properties which are managed or to be managed by the landlord, unless
advised otherwise, will be sent to your landlord upon all tenants signing the tenancy agreement. The
landlord will then register your holding deposit with a deposit scheme of their choice and provide you with
a deposit certificate.
METHODS OF PAYMENT
Cash, Cheque, Credit or Debit Card *for cheques please allow 5 working days to clear*
Internet Banking, Bank Transfer, or Standing Order
Bank Details for Direct Housing Ltd can be found at www.direct-housing.co.uk/payment
Signature*

Powered by Jotform SignClear
Name*

First NameLast Name
Date*

MonthDayYear
Date
Should be Empty:

Residential Application Form

Agreement to Pay Deposit