Chek Applecation Form Tait Mahaparikshgovin – Fill Out and Use This PDF

LPC QUICK CHECK APPLICATION

The most recent 2 years resident history required. Must provide dates of residency, landlord names and phone numbers for all addresses. The application cannot be submitted for processing until all information is provided.

Property Name_____________________________________ Unit #___________ Rent Amount _____________ Move in Date _____________

Roommates / Occupants Names and Birthdates (List only those that are applying with you today)

DOB:

DOB:

DOB:

Renter's InsuranceDo you carry renter's insurance? Yes_______ No _______

Carrier _______________________________ Agent _________________________________ Phone _________________________________

I understand that the property's insurance coverage and insurance does not and cannot protect any personal belongings against burglary, vandalism, fire, smoke, and other perils. I also understand that by not having personal liability insurance, I may be liable to third parties and to the property owner for certain perils which are covered by renter's insurance.

IF NO INSURANCE, OWNER AND ITS REPRESENTATIVES STRONGLY RECOMMEND THAT RESIDENT SECURES INSURANCE.

Have you, your spouse, roommate or occupant listed on this application ever been: Evicted or asked to move out? Sued for non-payment of rent? __________ Sued for damage to rental property? ___________ Convicted of a criminal offense?

Received deferred adjudication? ___________ . If yes please explain, year location and type of each:______________________________________

You represent that the answer is "No" to any question left blank.

LPC and Applicant acknowledge that Applicant has paid a non-refundable processing fee of $______. LPC acknowledges that Applicant has also paid a holding deposit.

in the amount of $_______. If Applicant fails or refuses, for any reason, to occupy the apartment and notifies LPC within 48 hours after signing the application of their

intention not to occupy the apartment, the holding deposit will be returned. If the Applicant fails to notify LPC of their cancellation within 48 hours of signing the Application, and fails to occupy the apartment, Lessor/Owner shall be entitled to damages of $_________ as administrative costs in addition to any and all damages

provided for in the Lease Contract, including but not limited to damages for lost rent due to Applicants breach of Lease. Applicant, Owner and LPC agree these administrative costs are a reasonable forecast of the expenses incurred as a result of Applicant's failure to occupy the apartment and in no event will be considered a penalty. All parties agree this sum is an enforceable liquidated damage amount. If the Applicant is approved, the holding deposit will be applied to the deposit upon commencement of the lease.

The facts set forth in my Application are true and complete. You are hereby authorized to make any investigation of my personal history and financial and credit record through any investigation of credit agencies or bureaus of your choice.

Resident Signature:

Date

Spouse Signature:

Date