Registration of Interest

"*" indicates required fields

IF YOU ARE COMPLETING THIS REGISTRATION OF INTEREST ON BEHALF OF SOMEONE, PLEASE ENTER YOUR NAME AND CONTACT DETAILS BELOW.

Are you applying as a single person or a couple?*

Single

Couple

Applicant Name

First Last

Applicant 2 Name

First Last

Email

Phone

Organisation (if applicable)

REGISTRATION OF INTEREST

Date*

Full name*

First Last

Current address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone number (mobile preferred)*

Please contact us if in the future this changes.

Email address*

Age*

Date of birth*

Reason for leaving current address*

Referred to Cottage Homes by whom*

PLEASE INDICATE IN ORDER OF PREFERENCE, WITH 1 BEING YOUR FIRST PREFERENCE WHICH LOCATION WOULD BE SUITABLE TO YOU. IF ONLY ONE SITE WOULD BE SUITABLE TO MAINTAIN AN EXISTING SUPPORT NETWORK, CONSIDER THIS WHEN COMPLETING THIS SECTION, HOWEVER UP TO 7 BOXES CAN BE NUMBERED.

Ascot Park

Glenelg*

Findon*

Toorak Gardens

Parkside

Prospect

Mitcham

*Glenelg & Findon have both ground & upstairs units (no lifts). Would you accept an upstairs unit?*

Yes

No

Do you own your own home?*

Yes

No

Do you own a pet?*

(If yes, please note that The Cottage Homes does not allow pets)

Yes

No

The Cottage Homes has a NO SMOKING policy for new residents, will this be an issue for you?*

Yes

No

Do you qualify for a Government Pensioner Medical Card?*

Yes

No

Do you receive a pension?*

Yes

No

Type of Pension*

Money in bank*

Numerical values only

ASSETS AS DISCLOSED TO CENTRELINK:

Superannuation Entitlement*

Numerical values only

Property*

Shares and Investments*

Motor Vehicles*

Household Effects*

Business Ownership*

Other

ie. valuables / collections (art, wine, antiques, vehicles)

Other

If you have entered a value for Other assets, please list these below:

Privacy Collection Notice*

I agree to the privacy collection notice.

The information in this application ("Information") is to be collected by Knight Frank Australia Pty Ltd (“Knight Frank”) to maintain a record of your interest in, and application for admission to, The Cottage Homes Incorporated, to verify your identity, to process and evaluate your application and to manage your occupation if your application is successful.

The application asks you to provide details of “Personal Information” and “Sensitive Information” as defined by the Privacy Act.

The Information may be disclosed during the course of your application or occupation for the purpose for which it was collected to other parties including the landlord, referees, guarantors, your doctor and relatives, financial institutions, tradespeople, third party operators of tenancy reference databases and other third parties as required by law. Further details of our disclosure practices can be obtained from us on request or by visiting our web site, www.knightfrank.com.au.

You may obtain access to the information that we hold about you by contacting us on 08 8233 5222 or writing to us at Level 29, Westpac House, 91 King William Street, Adelaide SA 5000, clearly marked "Cottage Homes - Privacy Information Request". You can correct this Information if it is inaccurate, incomplete, or out of date.

By signing this Notice, you consent to our collection, use and disclosure of the Information in accordance with this Notice. If you do not sign this Notice and do not provide your consent, we may not be able to process your application or manage your occupation.

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