Housing Application Home 5 Our Communications 5 Housing Application APPLICATION FOR HOUSING IN THE MANGATAWA PAPAKAINGA "*" indicates required fields Applicant details Full Name* Full Name Date of Birth MM slash DD slash YYYY Phone NumberMobile Phone*Email* Address Street ADdress City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country How long have you lived there? Years: Months: Please state why you are leaving this address: Have you applied to be on the Social Housing register through WINZ? * Yes No If you have do you know what your current social housing rating number is? Yes No IdentificationPlease provide photo identification, such as your driver’s licence.Max. file size: 100 MB.Driver’s License number: NB: Provision of this number is voluntary and will only be sued to verify your identity and for carrying out a credit check. Car / vehicle registration number: Make & model: Alternative form of ID: Shareholder Information If you are currently renting, please provide your landlord’s name and contact details. I am a Shareholder: * Yes No Shareholder number: Or I am nominated by my whanau trust which is a shareholder: Yes No Note: Mangatawa will confirm your nomination with the Trustees of the whanau trust. Name and shareholder number of whanau trust: Or I am a beneficiary of a shareholder: Yes No Shareholder number: Or I have a life interest from a shareholder: Yes No Name and shareholder number of whom life interest received: I am single Or I have a spouse / partner (we wish to rent as a couple): Name of my spouse / partner is: I / We are on a benefit: Yes No Name of benefit: Benefit customer number: We have …………. Children in our care The names and ages of our children are: add on another sheet if more rows requiredName Age GenderGenderMaleFemaleName Age GenderGenderMaleFemaleName Age GenderGenderMaleFemaleName Age GenderGenderMaleFemale Living assistance Do you or family members who will live with you have any permanent mobility issues: (e.g. use wheelchair, crutches, mobility scooter etc.? Please describe:*Do you or family members who will live with you require assisted living: e.g. a care giver (live-in or part time visiting): Please describe:* Emergency contact Full Name* Address* Phone Number Mobile Number* Email* May I contact this person for a reference?* Yes No Current landlord's details If you are currently renting, please provide your landlord’s name and contact details. Please describe your current living conditions:Landlord's name:* Phone Number Mobile Number* Email* May I contact this person for a reference? Yes No References Please provide two referees that I can contact. Referees can be a friend, co-worker, your employer or someone who knows you well: One of your referees should be able to provide a reference about your creditworthiness. If you have already provided your current landlord’s details, only one additional referee is needed. Please let these people know I may be contacting them for a reference. Referee name 1:* Phone*Email* Referee name 2:* Phone*Email* Required housing: State whether you wish to apply for a : 1 2 or 4 bedroom home State whether you wish to apply for a : Whanau rental home Kaumatua home License to Occupy home Signature: If necessary I agree to follow Kainga Ora process and be available for an assessment interview. I agree to follow the Mangatawa Papamoa Block Inc. rules as told to me during interview and in the Residents Information Booklet. I authorise the Landlord/Property Manager to: I authorise the Landlord/Property Manager to: Collect, retain and use this information for the purpose of assessing my creditworthiness and suitability for the tenancy; and Disclose information about me, whether collected from me directly or from any other source, to any other credit provider or any credit reporting agency for the purposes of providing or obtaining a credit report (which will involve the credit reporting agency providing information about me to the Landlord/Property Manager) Disclose information about me, whether collected from me directly or from any other source, to Tenancy Services for the purposes of providing or obtaining a tenancy report (which will involve the Tenancy Services agency providing information about me to the Landlord/Property Manager) Share information with and collect information from MSD (WINZ) if necessary (this may include requesting a Rent Redirection order to ensure rent payments are made as required I understand that the credit reporting agency: I authorise the Landlord/Property Manager to: May hold my information on their credit reporting database and use it for providing credit reporting services, and they may disclose my information to their subscribers for the purpose of credit checking or debt collection; and As part of providing a credit report, may check the Ministry of Justice fines database for any overdue fines I may have. Under the Privacy Act 1993, you have the right to ask for a copy of all information held about you, and have the right to request the correction of any incorrect information. Spam Protection
