Phot

o Si

ze:

3.5c

m x

4.5

cm

BROOKFIELDA c c o m m o d a t i o n

OFFICE USE ONLY

Notes:

Approved by:Declined by:

Room #Room Rate $ p/w

Bond $

Date: / /

Include with your application

a passport sized photo of

yourself. Please do not staple

it to the page.

RESIDENT APPLIC ATION FORMPlease �ll out the following using clearly printed capitals.Failure to complete may delay the application process.Please return the application form to the reception desk or by mail.

Current Address

PERSONAL DETAILSFirst Name(s)

Surname (Family name)

CONTACT DETAILS

Mobile Number

Work Phone Number

Nationality (e.g.: New Zealander)

Gender (please tick)

Male Female

Date of Birth (dd/mm/yyyy)

/ /

EMPLOYMENT DETAILS

Job Title

Organisation

Employer’s Name

REFEREES (excluding family members)

First Referee

Relationship to you

Contact Number

Second Referee

Relationship to you

Contact Number

Email Address

Length of Service (yy/mm/dd)

Access card #

Are you currently employed? yes no

Institution (e.g. University of Waikato)

Student ID#

When does/did your course start? (dd/mm/yyyy)

Quali�cation Title (e.g. Bachelor of Teaching)

/ /When do you intend to complete you course?

/ /

ACADEMIC INFORMATION Are you currently enrolled as a student? yes no

NEXT OF KIN

Full Name

Relationship to you (e.g. Parent/ Guardian)

Contact Number

/ /

Passport Number

Driver licence Number

ROOM PREFERENCE (please tick)Please note all accepted applications incur a non-refundable $55 admin fee.

Short stays incur a $50 refundable key deposit.

1 - 55 night(s) stay = $40 per night

Phone: +64 7 856 9700

Fax: +64 7 856 9703

Email: info@brook�eldaccommodation.co.nz

Address: Brook�eld Accommodation 45 Dey Street Hamilton East, 3216 HAMILTON NEW ZEALAND

O�ce Processing Hours: Mon - Fri 8.30am - 5.00 pm

Please allow 3 - 5 working days to process your application.If you have any questions or concerns regarding your application please contact us during o�ce hours.

Thank you for your application, we will contact you shortly with the outcome.

www.brook�eldaccommodation.co.nz

RESIDENCY

Direct Credit Automatic Payment

Payment Method (please tick - no cash payments)

Intended Arrival Date (dd/mm/yyyy)

Intended Date of Departure (dd/mm/yyyy)

/ /

VEHICLE DETAILS (if applicable)Please note all vehicles on site will incur a weekly fee of $5 (8 week min stay) or $2.50 (37 week min stay) for property access and security.

Vehicle type (Car / Motorbike / Van)

Registration # Colour

Make and Name (e.g. Toyota Corolla)

Date

BROOKFIELD ACCOMMODATION

APPLICANT AGREEMENT

I understand that by applying I am willing to abide byBrook�eld Accommodations ‘terms of residency’

I consent to Brook�eld Accommodation contacting my referees

I consent to Brook�eld Accommodation completing a police background check

I acknowledge that all rent and bond payments must be made via electronic banking by means of Direct Credit or through Automatic Payment. Manual payments may incur a $5 processing fee.

I understand that Brook�eld Accommodation may terminate my residency if the above information is intentionally incorrect

Applicant Signature

MEDICAL CONDITIONS Do you su�er from any long-term illnesses or injuries which we should be aware of?

Intended length of stay (please tick)

1-55 Day(s) 8 Weeks + 37 Weeks+

How did you hear about Brook�eld Accommodation?

CRIMINAL RECORD

Do you have any criminal convictions?

If yes please specify:

yes no

yes no

specify:

Why would you like to stay at Brook�eld Accommodation?

MARKETING

/ /

Bond for all weekly stays = 4 weeks rent

Single Room = $120.00 p/w

Large Single Room = $130.00 p/w

Single en suite = $150.00 p/w

Double Room = $170.00 p/w

Twin Room = $200.00 p/w

$100.00 p/w

$110.00 p/w

$140.00 p/w

$160.00 p/w

37 week minimum8 week minimum

Please note: the intended date of departure is approximateand we request that you provide two weeks notice prior to departure.

Do you require linen?$30 per length of stay (please tick one)

Y N