OFFICE USE ONLY Date:
/
/
Approved by: Declined by:
Room # Room Rate $ Bond $ Access card #
p/w
Notes:
OKFIELD B RO Accommodation
Please fill 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.
a passport sized photo of yourself. Please do not staple it to the page.
PERSONAL DETAILS First Name(s)
NEXT OF KIN
Surname (Family name)
Full Name
Date of Birth (dd/mm/yyyy)
/
Include with your application
Photo Size: 3.5cm x 4.5cm
R E S IDE N T A P P LI C AT I O N FOR M
Gender (please tick)
/
Male
Nationality (e.g.: New Zealander) Passport Number
Relationship to you (e.g. Parent/ Guardian)
Female Contact Number
Driver licence Number ACADEMIC INFORMATION Are you currently enrolled as a student? Institution (e.g. University of Waikato)
CONTACT DETAILS
yes
Mobile Number Student ID# Work Phone Number Qualification Title (e.g. Bachelor of Teaching) Email Address When does/did your course start? (dd/mm/yyyy)
/
/
When do you intend to complete you course?
Current Address
/
/
REFEREES (excluding family members) EMPLOYMENT DETAILS Are you currently employed? Job Title
First Referee yes
Relationship to you Contact Number
Organisation
Length of Service (yy/mm/dd)
/
no
/
Employer’s Name
Second Referee Relationship to you Contact Number
no
ROOM PREFERENCE (please tick) Please note all accepted applications incur a non-refundable $55 admin fee. 8 week minimum
Single Room
37 week minimum
= $120.00 p/w
$100.00 p/w
Large Single Room = $130.00 p/w
$110.00 p/w
Single en suite
= $150.00 p/w
$140.00 p/w
Double Room
= $170.00 p/w
$160.00 p/w
Twin Room
= $200.00 p/w
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)
MARKETING
Bond for all weekly stays = 4 weeks rent
How did you hear about Brookfield Accommodation? 1 - 55 night(s) stay
= $40 per night
Short stays incur a $50 refundable key deposit.
Why would you like to stay at Brookfield Accommodation?
Payment Method (please tick - no cash payments) Direct Credit
Automatic Payment
RESIDENCY Intended length of stay (please tick) 1-55 Day(s) 8 Weeks +
37 Weeks+
Do you require linen? $30 per length of stay (please tick one)
Y
specify:
Intended Arrival Date (dd/mm/yyyy)
/
CRIMINAL RECORD
/
Do you have any criminal convictions?
Intended Date of Departure (dd/mm/yyyy)
/
N
MEDICAL CONDITIONS Do you suffer from any long-term illnesses or injuries which we should be aware of? yes no
yes
no
If yes please specify:
/
Please note: the intended date of departure is approximate and we request that you provide two weeks notice prior to departure.
APPLICANT AGREEMENT
Office Processing Hours: Mon - Fri 8.30am - 5.00 pm
I understand that Brookfield Accommodation may terminate my residency if the above information is intentionally incorrect
Please allow 3 - 5 working days to process your application. If you have any questions or concerns regarding your application please contact us during office hours.
I understand that by applying I am willing to abide by Brookfield Accommodations ‘terms of residency’
Thank you for your application, we will contact you shortly with the outcome.
I consent to Brookfield Accommodation contacting my referees
BROOKFIELD ACCOMMODATION
I consent to Brookfield Accommodation completing a police background check
Phone: +64 7 856 9700
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.
Applicant Signature
Date
Fax:
+64 7 856 9703
Email:
info@brookfieldaccommodation.co.nz
Address:
Brookfield Accommodation 45 Dey Street Hamilton East, 3216 HAMILTON NEW ZEALAND
www.brookfieldaccommodation.co.nz