Repair Request

Please be as specific as possible when filling in this form. For eg, stipulate whether the appliance is gas or electric and include model numbers where possible. Thank you – we’ll get onto the job right away!

Please check that all requested documents are attached to this completed Licence Application form to ensure there are no delays in its processing:
- Copies of real estate licenses (individual & company) or copy of lodged application with receipt of payment.
- Copies of any relevant Trust Deed or Partnership Agreements (with all amendments).
- Privacy Consent, signed and dated.
- Copies of General (showing public liability amount) & Professional Indemnity Insurances.
- Copy of lease or agreement to lease (if applicable).
- Details of all relevant companies, trusts and partnerships.
- Current balance sheet.
- Assets and Liabilities Statement.
- Profit and Loss Statement for past 2 years (if currently trading as an agency).
- A copy of release from your previous real estate franchisor (if applicable).
- Copy of current drivers licence.
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IMPORTANT NOTE:
Please note your individual real estate and corporation licence application forms should not state the trading name as Living Here. The Office of Fair Trading should be advised of this only once the Licence Agreement has been signed. Instead please note your company/individual name in this section.
APPLICATION FOR LICENCE
1. OFFICE DETAILS
The business names of our offices appear as Living Here (Suburb). Please confirm your details:
Proposed Date of Commencement:
(At least 1 month from date of application, all real estate licences and insurances must be in place prior to this date)
Office Name:
State:
Office Address:
Office Phone:
Office Fax:
2. APPLICANT – PERSONAL DETAILS
Surname:
Other Names:
Title:
Date of birth:
Postal Address (for Living Here communications):
Residential Address:
Contact details:
Home:
Business:
Mobile:
May we contact you at your business number
- YES
- NO
Email address (for Living Here correspondence):
3. BUSINESS OWNER ENTITY AND DETAILS
IMPORTANT NOTE An office cannot attach or use the Business Name, the Living Here Name, the initials 'LH', or any combination of the above as a part of any corporate name. For example, if your company is registered as “LH North West Pty. Ltd.” then the company name will need to be changed to REMOVE the initials “LH”. If you need any assistance with the company name change, please don’t hesitate to contact the Franchise Legal Team on (07) 3231 2200.
Please print full name, as appropriate:
- Individual
- Company
- Trust Entity
- Partnership
Owners Name:
Trust Entity details (if applicable):
(if the Trust Entity is noted on your Trust Account receipt book, please provide a copy of the deposit slip)
ABN
ACN
Registered Address:
COMPANY DIRECTORS NAMES AND HOME ADDRESSES:
Name:
Address:
This person will also be a guarantor
Name:
Address:
This person will also be a guarantor
Name:
Address:
This person will also be a guarantor
LEASE DETAILS
Lessor:
Term:
Rental:
Renewal Periods:
Outgoings:
Security:
4. BUSINESS EXPERIENCE/EMPLOYMENT HISTORY
Have you had any experience in managing your own business?
- YES
- NO
Would you expect to devote your full time to the business?
- YES
- NO
If not, who would devote full time to the business:
Do you have an interest in any other franchise business or independent business?
- YES
- NO
If yes, give details, including the extent to which those interests may continue if you are granted a Living Here office
5. REFERENCES
BUSINESS REFERENCES Please provide names and contact numbers of three business referees who may be contacted about your application. These people may be asked to provide information about your past/present work performance or business skills. It is advisable to enclose a written reference from them.
First Referee:
Position Held:
Company & Ph. No:
Second Referee:
Position Held:
Company & Ph. No:
Third Referee:
Position Held:
Company & Ph. No:
CHARACTER REFERENCES
Please also include details of two persons who may be contacted for a character reference.
Name
Telephone Number
Name
Telephone Number
6. LEGAL CONSIDERATIONS
Have you ever been bankrupt or insolvent, or assigned your estate for the benefit of your creditors, or been connected with a company which has been placed under administration, receivership or liquidation under the provisions of the Corporations Law?
- YES
- NO
If “yes” please provide details:
Have legal proceedings ever been taken against you (or your company) for any debt?
- YES
- NO
If “yes” please provide details:
Have legal proceedings ever been taken against you (or your company)?
- YES
- NO
If “yes” please provide details:
Have you ever been charged or convicted of any criminal offence in any court or are you currently the subject of any charge pending before any court?
- YES
- NO
Do you have a valid driving licence?
- YES
- NO
Are there any special conditions?
- YES
- NO
If “yes” please provide details:
7. FINANCIAL DETAILS
Would you be seeking to borrow money to finance the office?
- YES
- NO
Have you prepared cash flow projections and a budget for twelve (12) months for the proposed office? (Please provide)
- YES
- NO
8. LICENCES
PLEASE NOTE: NO LICENCE AGREEMENT WILL BE EXECUTED UNLESS A COPY OF YOUR CURRENT REAL ESTATE LICENCES ARE ENCLOSED WITH THIS APPLICATION (TOGETHER WITH ALL CURRENT INSURANCES/CERTIFICATES OF CURRENCY)
For - Individual (Copy of licence MUST be enclosed)
R.E.A. Licence No:
Expiry Date of Licence:
Date Format: DD slash MM slash YYYY
Corporation (Copy of Corporation’s licence & licence of the Licensee in Charge MUST be enclosed)
Corporation Licence No:
Expiry Date of Licence:
Date Format: MM slash DD slash YYYY
Licensee in Charge No:
Expiry Date of Licence:
Date Format: MM slash DD slash YYYY
All -
Details of any other relevant licences:
Details of all relevant current insurances eg professional indemnity:
SOLICITOR’S NAME:
Address:
Phone Number:
ACCOUNTANT'S NAME:
Address:
Phone Number:
PRIVACY
PRIVACY DISCLOSURE STATEMENT We are an independently owned and operated business. We are bound by the National Privacy Principals. We collect personal information about you in this form to assess your application for eligibility as a business owner. We may need to collect information about you from your accountant, solicitor, nominated bank, your referees, relevant real estate licensing authorities, ASIC and credit reference database. The information on this Application will be held on our database and used by us. Your consent to us collecting this information is set out below. When the application is successful we may disclose your details to service providers relevant to the relationship between licensee and Living Here. You have the right to access personal information that we hold about you by contacting our privacy officer at Living Here Pty Ltd GPO Box 2433, Brisbane, Queensland, 4001; Telephone (07) 3231 2200 Facsimile: (07) 3831 9117. If you do not complete this form or do not sign the consent below then your application can not be processed and will not be considered.
PRIVACY CONSENT I/We, the Applicant/s acknowledge that I/We have read the above Privacy Notice. I/We authorise Living Here to collect information about me/us from my/our accountant, solicitor, nominated bank, referees, the relevant licensing authorities, ASIC and credit reference database. I/We also authorise Living Here to refer my/our details to other entities that are part of the Ray White Group, including, without limitation, Loan Market, Concierge (Ray White Insurance), White & Partners, Ray White Constructions and APMASPHERE).
Applicant
Date
Date Format: DD slash MM slash YYYY
Applicant
Date
Date Format: DD slash MM slash YYYY
DECLARATIONS I have completed this Licence Agreement application form to the best of my ability and warrant that all the information provided in it is true and correct. I understand that failure to make full disclosure may be construed as a misrepresentation by silence. I understand that any wrongful statements made by me are misrepresentations of fact. I undertake to keep confidential all commercially sensitive, proprietary Living Here information and information of a confidential nature, provided to me in the course of discussions and negotiations in relation to making application for a Living Here office. I authorise Living Here to make any enquiries that it considers necessary to fully assess this application. I understand Living Here may accept or reject this application in whole or in part in its absolute discretion and that there is no binding agreement with Ray White until a Licence Agreement is executed.
Applicant's Full Name (please print)
Witness' Full Name (please print)
Applicant's Full Name (please print)
Witness' Full Name (please print)
Applicant's Full Name (please print)
Witness' Full Name (please print)
Applicant's Full Name (please print)
Witness' Full Name (please print)
Date
Date Format: DD slash MM slash YYYY
Date
Date Format: DD slash MM slash YYYY
If the applicant is a company - a director of the company may complete this form. We may require further information, in due course, from each director and officer associated with the company. All guarantors must also sign as applicant.
If the applicant is a partnership – each partner must complete a separate form. All guarantors must also sign as applicant.
If several individuals or entities or a combination of individuals and entities, wish to apply jointly, then each legal entity must complete a separate form. All guarantors must also sign as applicant.
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IMPORTANT NOTE:

APPLICATION FOR LICENCE

1. OFFICE DETAILS

2. APPLICANT – PERSONAL DETAILS

Contact details:

3. BUSINESS OWNER ENTITY AND DETAILS

Trust Entity details (if applicable):

LEASE DETAILS

4. BUSINESS EXPERIENCE/EMPLOYMENT HISTORY

5. REFERENCES

CHARACTER REFERENCES

6. LEGAL CONSIDERATIONS

7. FINANCIAL DETAILS

8. LICENCES

For - Individual (Copy of licence MUST be enclosed)

Corporation (Copy of Corporation’s licence & licence of the Licensee in Charge MUST be enclosed)

All -

PRIVACY

Email

Email Agent

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