Cloetesville Housing & Backyard Dweller Survey

1
Full Name & Surname:
First Name
Last Name
2
ID Number:
3
Phone Number:
Area Code
Phone Number
4
Email
example@example.com
5
Household Income:
Value in Rand
6
Do you have a Spouse/Partner?
YESNO
7
Combined Household Income:
Owner: R_____
Spouse/Partner: R_____
8
Number of Children Living in the Household:
Please Select
Please Select
0
1
2
3
4
5
6
7
8
9
10
9
Number of backyard dwellings on the property:
1
2
3
4
5
6
7
8
9
10
Total Rental Collected per Month:
number in rand
11
I consent to share my personal information for the purpose of this survey and understand it will be used to assess housing options* This field is required.
12
Spouse/Partner Name:
First Name
Last Name
13
Spouse/Partner Details:
Please enter your ID number
Please enter your phone
Please enter your email
Please Select
Please Select
In Community of Property
Out of Community of Property
Out of Community of Property with Accrual
Traditional Rites
How married?
14
Address
Street Address
ERF Number
City
Province
Postal Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
15
Property Value:
Value in rand
Unsure
Less than R100 000
Between R100 000 & R250 000
Between R250 000 & R500 000
Between R500 000 & R1 million
More than R 1 million
16
Upload a copy of your latest rates account (optional)
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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17
Monthly Rates & Taxes – R ______
Up to date
In arrears
18
Title Deed Available?
YESNO
19
Please upload a copy if available?
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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20
Is the property bonded?
Yes
No
Paid off
21
Is the property insured?
Yes
No
Request a quote for insurance
22
Do you have a backyard tenant to record?
YESNO
23
Name
First Name
Last Name
24
Number
25
Email
example@example.com
26
Phone Number
Area Code
Phone Number
27
Employment status:
Employed
Temporary
Self-employed
Unemployed
Informal work
28
Monthly Income:
29
Do you receive a social grant?
YESNO
30
Number of children:
1
2
3
4
5
6
7
8
9
31
Are you interested in applying for a housing subsidy?
YESNO
32
Have you ever applied before?
YESNO
33
Would you want to own a formal unit here?
YESNO
34
Why?
35
Have you ever owned a property before?
YESNO
36
Number of rooms in current backyard dwelling:
Please Select
Please Select
1
2
3
4
5
6
7
8
37
Does the Tenant have a Spouse/Partner?
YESNO
38
Spouses Name:
First Name
Last Name
39
Spouse/Partner Details:
Please enter your ID number
Please enter your phone
Please enter your email
Please Select
Please Select
In Community of Property
Out of Community of Property
Out of Community of Property with Accrual
Traditional Rites
How married?
40
What would your ideal housing look like?
Brick House
Apartments
Own Property
More Rooms
Other
41
Biggest issue with your current living situation:
42
Water and electricity access?
Shared
Seperate
None
other
43
Would you be open to a sectional title scheme?
YESNO
44
What monthly payment could you afford for your own unit? R _____
45
Do you have more than R20 000 worth of debt?
YESNO
46
Do you have an active garnishee?
YESNO
47
Would you like help with budgeting, credit score, or financial planning?
YESNO
48
ID COPIES:
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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49
Proof of income:
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
50
Grant receipts
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
51
Final Notes/Comments
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: