Tenancy Application

This is a Tenancy Application form, which must be lodged by the applicant.

Please note that all the fields except ‘Languages’ are required to submit the form.

You can either complete the application form online below, or you can click HERE to download a printable Tenancy Application form. Once completed in hard copy, you can send to contact@emmauscommunity.org.au.

Tenant details
Application details

Tenant details

Tenant's first names*

Tenant's surname*

Tenant's email*

Tenant's date of birth (dd/mm/yyyy)*

Tenant's place of birth*

Contact address

Address Line 1*

Address Line 2

City*

State or Region*

Zip

Contact phone number

Main contact phone number*

Main contact phone number type*

Do you want to add another contact number?

NoYes

Second contact phone number*

Second contact phone number type*

Tenancy funding

Tenant's Income Source*

Does Public Trustee deal with your finances?*

YesNo

Tenant referrred by

Centrelink and Medicare details

CRN number*

Medicare number*

Medicare reference number*

Medicare expiry month*

Medicare expiry year*

Private medical cover

Do you have ambulance cover?*

YesNo

Tenancy Application

Tenant details

Contact address

Contact phone number

Tenancy funding

Centrelink and Medicare details

Private medical cover

Personal history and request

Tenant's Next of Kin

Emmaus Community

Contact