Online Rental Application Form

Application for Premises

The name of the premises you wish to rentUnit number you wish to rent

Full Name of person/company responsible for payment

First Name / Company nameLast Name / Company Reg no

E-mail

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

ID Number

Marital status

Current Employer

Occupation/ Title

Tel Number of Employer

Please enter a valid phone number.Format: (000) 000-0000.

Period of Employment (Years)

Address of Employer

Monthly Salary (Nett)

Name of Spouse

ID Number of Spouse

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Employer of Spouse

Occupation/ Title

Tel Number of Empoyer

Please enter a valid phone number.Format: (000) 000-0000.

Monthly Income (nett)

Period of Employment (Years)

Why are you moving?

Address of Current Residence

Street Address

Street Address Line 2

CityProvince

Postal / Zip CodeCountry

Have you ever been or are in the process of being declared insolvent?

Have you ever been under administration or are you in the process of being placed under administration?

If you answered yes to any of these questions, please explain:

Number of Persons to Occupy the premises:

1. Name and ID

Full NameID Number

Relationship

2. Name and ID

Full NameID Number

Relationship

3. Name and ID

Full NameID Number

Relationship

4. Name and ID

Full NameID Number

Relationship

Domestic worker?

Number of Vehicles

Other (trailer/boat/motorcycles)

Do you have pets?

Number of Pets?

Type/Breed

Are your Animals spayed/neutered?

Reference - Immediate Family

Full NameTel no:

Reference - Friends

Full NameTel no:

Reference - Previous Lessor

Full NameTel no:

I/We acknowledge that the Lessor is not under any obligation to accept this application and has the right to reject the application and doesn't have to give any reason for his decision.
I/We herewith grant permission for a Credit Record Enquiry to be done using the above personal information for purposes only of confirming my credit record and affordability based on the expenses which will be incurred monthly pertaining to this application.
I/We, the undersigned declare that the abovementioned information is true and correct.

Confirm

Date

Signature