Full Reference Application Form Step 1 of 5 20% Property DetailsBuilding/House Number*Building/House NameAddress Line 1*Address Line 2*Town*County*Postcode*Total Monthly Rent*Tenancy DetailsStart Date of Tenancy* Length of Tenancy (months)*Share of Rent*Applicant's DetailsApplicants Full Name* Title Select TitleMr.Mrs.MissMs.Dr.Prof.Rev. First Name Middle Name Last Name Previous Full Name(if your name has changed in the last 12 months)Date of Birth (dd/mm/yyyy)* Telephone Number*Mobile Number*Email Address* Marital Status*SingleMarriedDivorcedWidowedAdditional QuestionsCheck as appropriate Do you smoke? Do you have pets? Any recent Arrears or Adverse Credit? Do you have Children? If you have any recent arrears or adverse credit within the last 10 years, please provide details on the 'Additional Information' page. Applicants Current Address DetailsBuilding/House Number*Building/House NameAddress Line 1*Address Line 2*Town*County*Postcode*What is your current residency position? If 'Tenant', please complete the section titled 'Landlord/Agency Details' belowResidency Position* Tenant Owner Live with parents Family/Friends Please confirm the date you moved into the property* Landlord/Agency Details of your Current AddressBuilding/House NumberBuilding/House NameAddress Line 1Address Line 2TownCountyPostcodeName of Landlord/Letting AgentContact Email Address Contact Telephone NumberContact Full Name Title Select titleMr.Mrs.MissMs.Dr.Prof.Rev. First Name Last Name Current Rent Paid Per Calendar MonthApplicants Previous AddressBuilding/House NumberBuilding/House NameAddress Line 1Address Line 2TownCountyPostcodePlease confirm the date you moved into the property Please confirm the date you vacated the property Employment StatusEmployment Status*Check as Appropriate Employed (PAYE) Self-Employed Investments / Savings Benefits Students Other If 'Other', Please provide detailsEmployer NameAnnual Salary (Exc. Bonuses & Commission)Position/RoleTime with EmployerEmployer Contact Details Select Title Mr.Mrs.MissMs.Dr.Prof.Rev. Employer First Name Employer Last Name Primary Contact NumberSecondary Contact NumberContact Email Address Self EmployedBusiness NameAccountants NameTime Self EmployedAnnual Income (£)Accountant Contact Details Title Mr.Mrs.MissMs.Dr.Prof.Rev. First Name Last Name Primary Contact DetailsSecondary Contact NumberAccountant Email Address Accountants AddressIn EducationPlace of StudyGrant EntitlementCourse(s) StudyingLength of Course/StudiesOverseasEmployee NameMonthly Income (£)COS Reference NumberVISA TypeBenefit EntitlementBenefitsCheck all that apply Working Tax Credits Housing Benefit Disability Living Allowance Child Tax Credits Other If 'Other', Please give details IdentificationNational Insurance Number*Passport Number*Driving License NumberNext of KinName(s)*Relationship to you*Address*Phone Number*Email* If a situation arises whereby the letting agent can make contact with me, I consent to the letting agent making contact with my next of kin, the details of which I have supplied within this application. In the absence of direct communication with me, I authorise the letting agent to serve any notices or legal papers at the address of my next of kin. I have made my next of kin aware of this arrangement and can confirm I have their full authorityI have read and agree to the 'Next of Kin' Section of my application* Yes No Application Fee - Terms & Conditions Should your application be declined or you fail to proceed with the letting of the property, your application fee will be forfeitedI have read and agree to the 'Application Fee - Terms & Conditions' Section of my application* I Agree Bank Details Please complete this section with your bank details. VitalSpace will contact your bank to arrange a monthly standing order to be taken from this account for the amount you have specified on page 1. If you are applying to be a guarantor. Please complete with your details of your main bank account.Current account held?* Yes No Account Name (i.e. Mr John Smith)*Sort Code*Account Number*Bank Name*Approximate time with bank*Bank Address (including the post code)*Authorisation I confirm that the information provided in this application form is true, accurate and complete. I understand that the information that I have submitted will be used in order to assess my suitability to be granted a tenancy agreement and I give my consent to the information that I have provided being shared with third parties for this purpose. I understand and agree that current or former employers, landlords and letting agents may be asked to provide additional information about me or to verify information that I have provided. I further agree that the information that I have provided may be submitted to credit reference agencies in order that a credit check may be conducted. I expressly acknowledge that the authorising searches to be conducted and references obtained does not entitle me to see such searches or references and agree that I will direct any request for copies of searches or references to the relevant originating party and not to Rent4sure Limited. I understand that I may be refused a tenancy as a result of the searches and references obtained and agree that I shall not seek to hold Rent4sure Limited liable for such refusal nor shall I seek to bring any claim against Rent4sure Limited for any loss or damage suffered by me as a result of such refusal I understand that information which I provide or which is collected about me may be retained on file or stored electronically in accordance with the provisions of the Data Protection Act 1988. Contact consent*I do/do not want Rent4sure Limited, or their partner companies (e.g. Intasure), to contact me about related products and services which may be of interest to me, such as Tenants Contents Insurance. Do Contact Do Not Contact Applicants Name*Date* Authorisation* I Agree (signed) Additional InformationIf you need to provide any previous addresses, names, credit history or other credentials please describe them below.PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.