Application for occupancy.31 Ngata StPalmerston North PO Box 1603 Palmerston North 4440 New Zealand Your Details Name * First Name Last Name Email * Gender * Male Female Date of birth * MM DD YYYY Nationality * Current Address * Country * Smoker? * Yes No Home Phone Mobile * Occupation * Current Employer * Employer when you arrive in Palmerston North * Tertiary Institute you will be attending * Course Attending * Message Next of kin Name * Phone * Accommodation Date Accommodation Required from * MM DD YYYY Expected length of stay * Term Periodic Fixed Fixed term start and end date (if applicable) Checkbox PERIODIC: If for any reason my stay is terminated. I agree to give 3 week's notice or payment of 3 weeks. FIXED TERM: The tenancy cannot be terminated during the fixed term period. If I wish to be released from this fixed term contact I will still be liable for the full payment of the term of the contact. Periodic Fixed Your Room * Single Room (One person only) Double Room (Two people max) Do you have a vehicle? * Yes No Thank you!
