COVID19 Registration Form

Registration form to be completed by prospective Clients for Rental Appraisals, Tenants, Prospective Tenants, and Trades People before being granted access to the property / granting access to others to enter the current tenancy.

Name

Address of Property you are Registering to go to:

ID Number (ie passport/ Drivers Licence / Other)

Are you a:

Tenant Prospective Tenant Trades Person Other

Have you experienced symptoms of illness within the last 14 days?

Yes No

Have you got back from overseas in the last month?

Yes No

Have you been in contact with anyone who has become unwell in the last month?

Yes No

Are you considered vulnerable under the COVID-19 rules?

Yes No

Have you had COVID-19 and recovered?

Yes No

If you have answered YES to any of the Questions and need to clarify any information. Please do so here:

Please note, when entering the property all COVID-19 proper health and safety procedures must be followed, including 2m distancing and wearing masks and gloves where appropriate. This includes for all current residents where other people are entering the premises, e.g trades people etc.

Declaration

I confirm that the information provided is true and accurate. I understand that this information may be passed onto other people (tenants, trades peoples, etc) intending to enter the property, or who currently reside at the property. I understand the Ministry of Health may required to use this information for social tracing.

Signed:

Date:

Current Address you are residing at:

Phone number:

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